Mustafa Reem A, Wiercioch Wojtek, Falavigna Maicon, Zhang Yuan, Ivanova Liudmila, Arevalo-Rodriguez Ingrid, Cheung Adrienne, Prediger Barbara, Ventresca Matthew, Brozek Jan, Santesso Nancy, Bossuyt Patrick, Garg Amit X, Lloyd Nancy, Lelgemann Monika, Bühler Diedrich, Schünemann Holger J
Department of Health Research Methods, Evidence and Impact (formerly "Clinical Epidemiology and Biostatistics"), McMaster University, 1280 Main Street West Hamilton, ON L8S 4K1, Canada; Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, MS3002, Kansas City, KS 66160, USA.
Department of Health Research Methods, Evidence and Impact (formerly "Clinical Epidemiology and Biostatistics"), McMaster University, 1280 Main Street West Hamilton, ON L8S 4K1, Canada.
J Clin Epidemiol. 2017 Dec;92:29-37. doi: 10.1016/j.jclinepi.2017.09.007. Epub 2017 Sep 12.
The objective of this study was to identify and describe critical appraisal tools designed for assessing the quality of evidence (QoE) and/or strength of recommendations (SoRs) related to health care-related tests and diagnostic strategies (HCTDSs).
We conducted a systematic review to identify tools applied in guidelines, methodological articles, and systematic reviews to assess HCTDS.
We screened 5,534 titles and abstracts, 1,004 full-text articles, and abstracted data from 330 references. We identified 29 tools and 14 modifications of existing tools for assessing QoE and SoR. Twenty-three out of 29 tools acknowledge the importance of assessing the QoE and SoR separately, but in 8, the SoR is based solely on QoE. When making decisions about the use of tests, patient values and preferences and impact on resource utilization were considered in 6 and 8 tools, respectively. There is also confusion about the terminology that describes the various factors that influence the QoE and SoR.
Although at least one approach includes all relevant criteria for assessing QoE and determining SoR, more detailed guidance about how to operationalize these assessments and make related judgments will be beneficial. There is a need for a better description of the framework for using evidence to make decisions and develop recommendations about HCTDS.
本研究的目的是识别和描述为评估与医疗保健相关检测和诊断策略（HCTDSs）相关的证据质量（QoE）和/或推荐强度（SoRs）而设计的批判性评价工具。
我们进行了一项系统评价，以识别在指南、方法学文章和系统评价中用于评估HCTDS的工具。
我们筛选了5534篇标题和摘要、1004篇全文文章，并从330篇参考文献中提取了数据。我们识别出29种用于评估QoE和SoR的工具以及对现有工具的14种修改。29种工具中有23种承认分别评估QoE和SoR的重要性，但在8种工具中，SoR仅基于QoE。在做出关于检测使用的决策时，分别有6种和8种工具考虑了患者价值观和偏好以及对资源利用的影响。对于描述影响QoE和SoR的各种因素的术语也存在混淆。
尽管至少有一种方法包含了评估QoE和确定SoR的所有相关标准，但关于如何实施这些评估并做出相关判断的更详细指导将是有益的。需要更好地描述利用证据做出关于HCTDS的决策和制定推荐的框架。
