A case study of an individual participant data meta-analysis of diagnostic accuracy showed that prediction regions represented heterogeneity well

The diagnostic accuracy of a screening tool is often characterized by its sensitivity and specificity. An analysis of these measures must consider their intrinsic correlation. In the context of an individual participant data meta-analysis, heterogeneity is one of the main components of the analysis. When using a random-effects meta-analytic model, prediction regions provide deeper insight into the effect of heterogeneity on the variability of estimated accuracy measures across the entire studied population, not just the average. This study aimed to investigate heterogeneity via prediction regions in an individual participant data meta-analysis of the sensitivity and specificity of the Patient Health Questionnaire-9 for screening to detect major depression. From the total number of studies in the pool, four dates were selected containing roughly 25%, 50%, 75% and 100% of the total number of participants. A bivariate random-effects model was fitted to studies up to and including each of these dates to jointly estimate sensitivity and specificity. Two-dimensional prediction regions were plotted in ROC-space. Subgroup analyses were carried out on sex and age, regardless of the date of the study. The dataset comprised 17,436 participants from 58 primary studies of which 2322 (13.3%) presented cases of major depression. Point estimates of sensitivity and specificity did not differ importantly as more studies were added to the model. However, correlation of the measures increased. As expected, standard errors of the logit pooled TPR and FPR consistently decreased as more studies were used, while standard deviations of the random-effects did not decrease monotonically. Subgroup analysis by sex did not reveal important contributions for observed heterogeneity; however, the shape of the prediction regions differed. Subgroup analysis by age did not reveal meaningful contributions to the heterogeneity and the prediction regions were similar in shape. Prediction intervals and regions reveal previously unseen trends in a dataset. In the context of a meta-analysis of diagnostic test accuracy, prediction regions can display the range of accuracy measures in different populations and settings

Routine screening for depression in patients with coronary heart disease never mind

A recent Science Advisory from the American Heart Association (AHA) recommended routine screening of all patients with coronary heart disease (CHD) for depression. The authors of the advisory noted that the high prevalence of depression in patients with CHD supports this strategy. A systematic review of the evidence on depression screening and treatment in CHD patients published soon after the AHA advisory found that screening tools for major depression are reasonably accurate among patients with CHD, but that the majority of patients who screen positive will not have major depression; that depression treatment in CHD patients only accounts for a small amount of variance in depression symptom change scores; and that there is no evidence that screening for depression improves CHD outcomes. We call for the AHA to reassess their recommendations in light of this systematic review and considering the potential impact of their document on clinical practice. (J Am Coll Cardiol 2009; 54:886-90) (C) 2009 by the American College of Cardiology Foundation

The accuracy of two brief screening questions for detecting a history of physical or sexual abuse in childhood

A number of medical practice guidelines and recommendations call for screening adult patients for a history of physical or sexual abuse in childhood, but no brief screening tools exist. The objective of this study was to assess the accuracy of a two-item screener for physical or sexual abuse in childhood. Methods: This is a cross-sectional study of randomly selected women (aged 18-65 years) from a large health maintenance organization. One thousand two hundred twenty-five patients were administered a questionnaire, which included two items in a brief screener: (a) "when I was growing up, people in my family hit me so hard that it left me with bruises or marks" and (b) "When I was growing up, someone tried to touch me in a sexual way or tried to make me touch them." A subset of 216 patients completed a semistructured interview for a history of physical or sexual abuse in childhood. Results: The two-item screener was sensitive (84.8%) and specific (88.1%) for detecting a history of physical or sexual abuse in childhood, as determined by the semistructured interview. Conclusions: The two-item screener provides an accurate tool, which is easily integrated into a comprehensive health questionnaire or administered verbally by a clinician, to assess for history of abuse

The accuracy of two brief screening questions for detecting a history of physical or sexual abuse in childhood

A number of medical practice guidelines and recommendations call for screening adult patients for a history of physical or sexual abuse in childhood, but no brief screening tools exist. The objective of this study was to assess the accuracy of a two-item screener for physical or sexual abuse in childhood. Methods: This is a cross-sectional study of randomly selected women (aged 18-65 years) from a large health maintenance organization. One thousand two hundred twenty-five patients were administered a questionnaire, which included two items in a brief screener: (a) "when I was growing up, people in my family hit me so hard that it left me with bruises or marks" and (b) "When I was growing up, someone tried to touch me in a sexual way or tried to make me touch them." A subset of 216 patients completed a semistructured interview for a history of physical or sexual abuse in childhood. Results: The two-item screener was sensitive (84.8%) and specific (88.1%) for detecting a history of physical or sexual abuse in childhood, as determined by the semistructured interview. Conclusions: The two-item screener provides an accurate tool, which is easily integrated into a comprehensive health questionnaire or administered verbally by a clinician, to assess for history of abuse