如何批判性评价和解读诊断准确性的系统评价和荟萃分析：使用指南。
How to Critically Appraise and Interpret Systematic Reviews and Meta-Analyses of Diagnostic Accuracy: A User Guide.
机构信息
From the Department of Radiology, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9 (R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M., H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.); Institute of Applied Health Research, University of Birmingham, Birmingham, UK (Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK (Y.T.); Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada (B.L.).
出版信息
Radiology. 2023 May;307(3):e221437. doi: 10.1148/radiol.221437. Epub 2023 Mar 14.
Systematic reviews of diagnostic accuracy studies can provide the best available evidence to inform decisions regarding the use of a diagnostic test. In this guide, the authors provide a practical approach for clinicians to appraise diagnostic accuracy systematic reviews and apply their results to patient care. The first step is to identify an appropriate systematic review with a research question matching the clinical scenario. The user should evaluate the rigor of the review methods to evaluate its credibility (Did the review use clearly defined eligibility criteria, a comprehensive search strategy, structured data collection, risk of bias and applicability appraisal, and appropriate meta-analysis methods?). If the review is credible, the next step is to decide whether the diagnostic performance is adequate for clinical use (Do sensitivity and specificity estimates exceed the threshold that makes them useful in clinical practice? Are these estimates sufficiently precise? Is variability in the estimates of diagnostic accuracy across studies explained?). Diagnostic accuracy systematic reviews that are judged to be credible and provide diagnostic accuracy estimates with sufficient certainty and relevance are the most useful to inform patient care. This review discusses comparative, noncomparative, and emerging approaches to systematic reviews of diagnostic accuracy using a clinical scenario and examples based on recent publications.
系统评价诊断准确性研究可以提供最佳的现有证据，以告知关于使用诊断测试的决策。在本指南中，作者为临床医生提供了一种实用的方法来评估诊断准确性系统评价，并将其结果应用于患者护理。第一步是确定与临床情况相匹配的适当系统评价，并提出研究问题。用户应评估审查方法的严谨性，以评估其可信度（审查是否使用明确界定的纳入标准、全面的搜索策略、结构化的数据收集、偏倚风险和适用性评估以及适当的荟萃分析方法？）。如果审查是可信的，下一步是决定诊断性能是否足以用于临床应用（敏感性和特异性估计值是否超过使其在临床实践中有用的阈值？这些估计值是否足够精确？研究间诊断准确性估计值的变异性是否可以解释？）。被认为是可信的、提供具有足够确定性和相关性的诊断准确性估计值的诊断准确性系统评价对告知患者护理最有用。本综述讨论了使用临床情况和基于最近出版物的示例的诊断准确性系统评价的比较、非比较和新兴方法。
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