Systematic reviews of diagnostic tests in endocrinology: an audit of methods, reporting, and performance
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Systematic reviews of diagnostic tests in endocrinology: an audit of methods, reporting, and performance Gabriela Spencer-Bonilla1,2 Naykky Singh Ospina1,3 Rene Rodriguez-Gutierrez1,4 Juan P. Brito1,5 Nicole Iñiguez-Ariza5 Shrikant Tamhane1,5 Patricia J. Erwin6 M. Hassan Murad1,7 Victor M. Montori1,5 ●
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Received: 24 January 2017 / Accepted: 1 April 2017 © Springer Science+Business Media New York 2017
Abstract Background Systematic reviews provide clinicians and policymakers estimates of diagnostic test accuracy and their usefulness in clinical practice. We identified all available systematic reviews of diagnosis in endocrinology, summarized the diagnostic accuracy of the tests included, and assessed the credibility and clinical usefulness of the methods and reporting. Methods We searched Ovid MEDLINE, EMBASE, and Cochrane CENTRAL from inception to December 2015 for systematic reviews and meta-analyses reporting accuracy
Electronic supplementary material The online version of this article (doi:10.1007/s12020-017-1298-1) contains supplementary material, which is available to authorized users. Naykky Singh Ospina and Gabriela Spencer-Bonilla contributed equally to this work. * Victor M. Montori [email protected] 1
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
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School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
3
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Florida, Gainesville, FL, USA
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Division of Endocrinology, Department of Internal Medicine, University Hospital “Dr. Jose E. Gonzalez”, Autonomous University of Nuevo Leon, Monterrey, MX, USA
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Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
6
Mayo Medical Library, Mayo Clinic, Rochester, MN 55905, USA
7
Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN, USA
measures of diagnostic tests in endocrinology. Experienced reviewers independently screened for eligible studies and collected data. We summarized the results, methods, and reporting of the reviews. We performed subgroup analyses to categorize diagnostic tests as most useful based on their accuracy. Results We identified 84 systematic reviews; half of the tests included were classified as helpful when positive, onefourth as helpful when negative. Most authors adequately reported how studies were identified and selected and how their trustworthiness (risk of bias) was judged. Only one in three reviews, however, reported an overall judgment about trustworthiness and one in five reported using adequate meta-analytic methods. One in four reported contacting authors for further information and about half included only patients with diagnostic uncertainty. Conclusion Up to half of the diagnostic endocrine tests in which the likelihood ratio was calculated or provided are likely to be helpful in practice when positive as are onequarter when negative. Most diagnostic systema
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