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Systematic reviews and meta-analyses of test accuracy: developing methods that meet practitioners’ needs

By Clare Frances Davenport

Abstract

Testing can be a substantial driver of health care costs. Increase in test use over recent decades has occurred despite disappointing results from test accuracy evaluations. Poor quality and reporting of primary test accuracy studies and difficulties with understanding and application of test accuracy information are purported to be important contributors to this observed evidence ‘gap’. \ud \ud The objectives of this thesis were to:\ud * Systematically review evidence concerning the understanding and application of test accuracy metrics.\ud * Undertake primary research building on the review of understanding and application.\ud * Assess whether the contribution of test accuracy reviews to the test accuracy evidence base is compromised by deficiencies in their contextual fit, or of included primary studies.\ud \ud Existing research concerned with understanding and application of test accuracy information is not driven by the needs of decision makers. Contrary to the prevailing view in the literature, findings of original research from this thesis demonstrate that probability revision is not a feature of diagnostic decision making. Choice of test accuracy metric however was shown to have a profound influence on diagnostic decision making. Deficiencies in question formulation and contextualisation of test accuracy reviews are undermining their contribution to the test accuracy evidence base.\u

Topics: RA0421 Public health. Hygiene. Preventive Medicine, RC Internal medicine
Year: 2012
OAI identifier: oai:etheses.bham.ac.uk:3427

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  1. (2011). 109. Searches were carried out in
  2. (2007). 3.6 Yield of Test Accuracy Reviews By Database (including duplicates across databases)
  3. (2006). 4.4 Methods 4.4.1 Search strategy Published reviews were sought by interrogation of the DARE (Database of Abstracts of Reviews of Effectiveness, Centre for Reviews and Dissemination,
  4. (2006). All searches stopped
  5. Notes to fig 3.4: TA: Test Accuracy; Effect: Effectiveness; C-E: Cost-Effectiveness; Method: Methodological review; Multiple: Review with multiple purposes
  6. Notes to Fig 3.5: OTC: Over The Counter; Com diag: Community diagnosis; Second diag: Diagnosis in secondary care; Multiple: Multiple settings explicitly specified; Unclear: Clinical setting unclear
  7. Table 3.3: Content of review databases according to review purpose Review purpose HTA (N=333) DARE (N=383) Medion (N=664) C-EBLM (N=401) ARIF (N=491) Total (N=1620) Test Accuracy (1
  8. (1996). The analysis did not include the NHS EED database or the CDSR database. CDSR does not claim to include systematic reviews of test accuracy studies although our search filter identified 16 hits from CDSR between
  9. (1990). type and place of publication of included reviews The date of publication of the 100 reviews spanned
  10. (2006). Unpublished reviews were sought by interrogating the National Research Register http://www.nrr.nhs.uk/search.htm

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