Clinical diagnosis rests on the integration of complex sets of information, from disease prevalence to patient history, clinical signs, and ancillary tests, finally pivoting on the chosen diagnostic test. While the goal of accurate diagnosis is eventually improving clinical outcomes while leading to appropriately use of the available resources, this is often challenging or redundant. Accordingly, diagnostic accuracy rests on the comparison between the index test and one or more references tests, across several dimensions of accuracy which include but are not limited to sensitivity and specificity. Adding complexity, in the era of globalized healthcare and electronic health records, it is impossible or naïve to rest decision-making on a single clinical study, even if large and valid. Only the credible synthesis of several multiple studies in a systematic review can thus confirm accuracy and internal validity while boosting external validity and appraising moderators. Meta-analysis of diagnostic test accuracy studies aims exactly at this. By pooling several different studies sharing some common content, scope, and validity features, it can prove as a useful tool for clinical synthesis and evidence-based practice. Knowledge of the subtleties involved in its design, conduct, analysis, interpretation, and application of meta-analysis of diagnostic test accuracy studies is required for all careful researchers and practitioners aiming to exploit rather than be dominated by the information era in the clinical and scholarly realm.
KeywordsAccuracy Diagnosis Evidence-based medicine Meta-analysis Systematic review
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