title: Challenges in systematic reviews of diagnostic technologies.
abstract: Diagnostic tests are critical components of effective health care. They help determine treatments that are most beneficial for a given patient. Their assessment is a complex process that includes such challenges as a dearth of studies that evaluate clinical outcomes and lack of data on use of the test in realistic clinical settings. The methodologic quality of studies of diagnostic tests also lags behind the quality of studies of therapeutic interventions. Statistical methods to combine diagnostic accuracy data are more complex and not as well developed, leading to difficulties in the interpretation of results. The Agency for Healthcare Research and Quality Technology Assessment Program has adopted a 6-level framework for evaluating diagnostic technologies. The model emphasizes the need for systematic reviews of diagnostic test studies to go beyond the assessment of technical feasibility and accuracy to examine the impact of the test on health outcomes. In this paper, we use examples from 3 Evidence-based Practice Center reports to illustrate 3 challenges reviewers may face when reviewing diagnostic test literature: finding relevant studies, assessing methodologic quality of diagnostic accuracy studies, and synthesizing studies that evaluate tests in different patient populations or use different outcomes.
authors.affiliation: Tufts-New England Medical Center Evidence-based Practice Center, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
authors.forename: Athina
authors.initials: A
authors.lastname: Tatsioni
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Zarin
authors.forename: Naomi
authors.initials: N
authors.lastname: Aronson
authors.forename: David J
authors.initials: DJ
authors.lastname: Samson
authors.forename: Carole R
authors.initials: CR
authors.lastname: Flamm
authors.forename: Christopher
authors.initials: C
authors.lastname: Schmid
authors.forename: Joseph
authors.initials: J
authors.lastname: Lau
mesh_terms: D019937:Diagnostic Techniques and Procedures / Q000592:standards*; D003935:Diagnostic Techniques, Cardiovascular / Q000592:standards; D019317:Evidence-Based Medicine / Q000379:methods* / Q000592:standards; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000592:standards; D049268:Positron-Emission Tomography / Q000592:standards; D012196:Review Literature as Topic; D013673:Technology Assessment, Biomedical / Q000592:standards*