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Small-study effects and time trends in diagnostic test accuracy meta-analyses: a meta-epidemiological study
Wynanda Annefloor van Enst1,2, Christiana A Naaktgeboren3, Eleanor A Ochodo4,5
1Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. a.vanenst@kennisinstituut.nl.
Systematic Reviews
|May 10, 2015
Summary
Small-study effects and time trends are less pronounced in diagnostic test accuracy meta-analyses compared to randomized trials. Imaging studies show reversed small-study effects, with larger studies reporting higher sensitivity.
Area of Science:
- Medical Statistics
- Diagnostic Test Evaluation
- Meta-Analysis Methodology
Background:
- Small-study effects and time trends are known phenomena in meta-analyses of randomized trials.
- The presence of these effects in meta-analyses of diagnostic test accuracy studies remains underexplored.
- This study investigates the extent to which these effects manifest in diagnostic test accuracy meta-analyses.
Purpose of the Study:
- To determine if small-study effects are present in meta-analyses of diagnostic test accuracy studies.
- To assess if time trends influence accuracy estimates in diagnostic test meta-analyses.
- To compare the magnitude of these effects with those observed in randomized trial meta-analyses.
Main Methods:
- Systematic search for test accuracy meta-analyses published between May and September 2012.
- Utilized meta-regression to evaluate associations between accuracy estimates (diagnostic odds ratio, sensitivity, specificity) and sample size.
- Employed meta-regression to assess associations between accuracy estimates and time since first publication, summarizing coefficients using random-effects meta-analysis.
Main Results:
- Analysis of 46 meta-analyses (859 primary studies) revealed non-significant small-study effects for the diagnostic odds ratio (DOR).
- In imaging studies, a significant increase in sensitivity was observed with larger sample sizes (1.13 per 100 additional diseased subjects).
- Sensitivity showed a significant decrease in studies published later (relative change 0.89), while DOR trends over time were non-significant.
Conclusions:
- Small-study effects and time trends appear less prominent in diagnostic test accuracy meta-analyses than in randomized trial meta-analyses.
- A reversed small-study effect was noted in imaging studies, where larger studies reported higher sensitivity.
- The findings suggest potential differences in the manifestation of study-level biases across different types of meta-analytic research.
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