过度解读研究结果：诊断准确性研究系统评价中的“歪曲”证据。

Overinterpretation of Research Findings: Evidence of "Spin" in Systematic Reviews of Diagnostic Accuracy Studies.

机构信息

University of Ottawa, Ottawa, Ontario, Canada.

University of Ottawa Department of Radiology. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada;

出版信息

Clin Chem. 2017 Aug;63(8):1353-1362. doi: 10.1373/clinchem.2017.271544. Epub 2017 Jun 12.

DOI:10.1373/clinchem.2017.271544

PMID:28606911

Abstract

BACKGROUND

We wished to assess the frequency of overinterpretation in systematic reviews of diagnostic accuracy studies.

METHODS

MEDLINE was searched through PubMed from December 2015 to January 2016. Systematic reviews of diagnostic accuracy studies in English were included if they reported one or more metaanalyses of accuracy estimates. We built and piloted a list of 10 items that represent actual overinterpretation in the abstract and/or full-text conclusion, and a list of 9 items that represent potential overinterpretation. Two investigators independently used the items to score each included systematic review, with disagreements resolved by consensus.

RESULTS

We included 112 systematic reviews. The majority had a positive conclusion regarding the accuracy or clinical usefulness of the investigated test in the abstract (n = 83; 74%) and full-text (n = 83; 74%). Of the 112 reviews, 81 (72%) contained at least 1 actual form of overinterpretation in the abstract, and 77 (69%) in the full-text. This was most often a "positive conclusion, not reflecting the reported summary accuracy estimates," in 55 (49%) abstracts and 56 (50%) full-texts and a "positive conclusion, not taking high risk of bias and/or applicability concerns into account," in 47 abstracts (42%) and 26 full-texts (23%). Of these 112 reviews, 107 (96%) contained a form of potential overinterpretation, most frequently "nonrecommended statistical methods for metaanalysis performed" (n = 57; 51%).

CONCLUSIONS

Most recent systematic reviews of diagnostic accuracy studies present positive conclusions and a majority contain a form of overinterpretation. This may lead to unjustified optimism about test performance and erroneous clinical decisions and recommendations.

摘要

背景

我们旨在评估系统评价诊断准确性研究中过度解读的频率。

方法

通过 PubMed 中的 MEDLINE 从 2015 年 12 月至 2016 年 1 月进行检索。如果系统评价报告了一项或多项准确性估计的荟萃分析，则纳入英文的诊断准确性研究。我们构建并试点了一个包含 10 个项目的列表，这些项目代表摘要和/或全文结论中的实际过度解读，以及 9 个项目的列表，这些项目代表潜在的过度解读。两位研究者独立使用这些项目对每个纳入的系统评价进行评分，分歧通过共识解决。

结果

我们纳入了 112 项系统评价。大多数系统评价在摘要（n=83；74%）和全文（n=83；74%）中对所研究的检测的准确性或临床有用性得出了积极的结论。在 112 项综述中，81 项（72%）在摘要中至少包含 1 种实际形式的过度解读，77 项（69%）在全文中包含过度解读。最常见的是在 55 篇摘要（49%）和 56 篇全文（50%）中“积极的结论，但未反映报告的综合准确性估计”，在 47 篇摘要（42%）和 26 篇全文（23%）中“积极的结论，但未考虑高偏倚和/或适用性问题”。在这 112 项综述中，107 项（96%）包含了一种潜在的过度解读形式，最常见的是“进行荟萃分析时未采用推荐的统计方法”（n=57；51%）。