Systematic reviews in health care - Systematic reviews of evaluations of diagnostic and screening
Systematic reviews in health care - Systematic reviews of evaluations of diagnostic and screening
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DOI：
10.1136/bmj.323.7305.157
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发表时间：
2001-07-21
影响因子：
--
通讯作者：
Deeks, JJ
中科院分区：
文献类型：
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作者：
Deeks, JJ
测试通常用于医学筛查，诊断，分级和监测疾病的进展。诊断信息可从多种来源获得，包括成像和生化技术、病理学和心理学调查以及在病史采集和临床检查期间引起的体征和症状。1这些信息中的每一项都可以被视为单独的诊断或筛查“测试”的结果。对检测评价进行系统性综述的原因与对治疗干预进行系统性综述的原因相同：根据所有可用证据对检测性能和影响进行估计，评价已发表研究的质量，并说明研究结果之间的差异。2-5对诊断准确性研究的回顾涉及相同的关键阶段，即定义问题、检索文献、评估研究的合格性和质量以及提取和综合数据。然而，评估测试准确性的研究具有独特的设计，需要不同的标准来适当评估研究的质量和偏倚的可能性。此外，每项研究报告了一对相关的汇总统计量（例如敏感性和特异性），而不是单个统计量（例如风险比），因此需要不同的统计方法来汇总研究结果。本文主要讨论了Meta分析中研究质量的维度以及不同汇总统计量在整合研究中的优缺点。其他方面，包括文献检索和进一步的技术细节，在其他地方讨论。6
Tests are routinely used in medicine to screen for, diagnose, grade, and monitor the progression of disease. Diagnostic information is obtained from a multitude of sources, including imaging and biochemical technologies, pathological and psychological investigations, and signs and symptoms elicited during history taking and clinical examinations. 1 Each of these items of information can be regarded as a result of a separate diagnostic or screening “test.” Systematic reviews of evaluations of tests are undertaken for the same reasons as systematic reviews of treatment interventions: to produce estimates of test performance and impact based on all available evidence, to evaluate the quality of published studies, and to account for variation in findings between studies. 2–5 Reviews of studies of diagnostic accuracy involve the same key stages of defining questions, searching the literature, evaluating studies for eligibility and quality, and extracting and synthesising data. However, studies that evaluate the accuracy of tests have a unique design requiring different criteria to appropriately assess the quality of studies and the potential for bias. Additionally, each study reports a pair of related summary statistics (for example, sensitivity and specificity) rather than a single statistic (such as a risk ratio) and hence requires different statistical methods to pool the results of the studies. This article concentrates on the dimensions of study quality and the advantages and disadvantages of different summary statistics for combining studies in meta-analysis. Other aspects, including searching the literature and further technical details, are discussed elsewhere. 6