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How to Critically Appraise and Interpret Systematic Reviews and Meta-Analyses of Diagnostic Accuracy: A User Guide
Robert A Frank1, Jean-Paul Salameh1, Nayaar Islam1
1From the Department of Radiology, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M., H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.); Institute of Applied Health Research, University of Birmingham, Birmingham, UK (Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK (Y.T.); Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada (B.L.).
This guide helps clinicians appraise diagnostic accuracy systematic reviews. It outlines steps to assess review credibility and diagnostic test performance for patient care decisions.
Area of Science:
- Medical Informatics
- Clinical Epidemiology
- Diagnostic Test Evaluation
Background:
- Systematic reviews of diagnostic accuracy studies offer high-quality evidence for clinical decision-making.
- Appraising these reviews is crucial for effectively integrating diagnostic test results into patient care.
Purpose of the Study:
- To provide clinicians with a practical framework for evaluating diagnostic accuracy systematic reviews.
- To guide the application of findings from these reviews to clinical practice.
Main Methods:
- Identifying relevant systematic reviews matching clinical scenarios.
- Assessing the methodological rigor and credibility of the review process.
- Evaluating the diagnostic performance metrics (sensitivity, specificity) and their clinical utility.
Main Results:
- Credible reviews with clearly defined methods and comprehensive searches are essential.
- Diagnostic accuracy estimates must be sufficiently precise and clinically relevant.
- Variability in accuracy across studies should be explained for reliable application.
Conclusions:
- Clinicians can effectively use credible systematic reviews to inform diagnostic test selection.
- Rigorous appraisal ensures that diagnostic accuracy data supports optimal patient management.
- Understanding review methodology and performance metrics enhances clinical judgment.
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