title: Reporting quality of diagnostic accuracy studies: a systematic review and meta-analysis of investigations on adherence to STARD.
abstract: BACKGROUND
  Poor reporting of diagnostic accuracy studies impedes an objective appraisal of the clinical performance of diagnostic tests. The Standards for Reporting of Diagnostic Accuracy Studies (STARD) statement, first published in 2003, aims to improve the reporting quality of such studies.
  
  
  OBJECTIVE
  To investigate to which extent published diagnostic accuracy studies adhere to the 25-item STARD checklist, whether the reporting quality has improved after STARD's launch and whether there are any factors associated with adherence.
  
  
  METHODS
  We performed a systematic review and searched MEDLINE, EMBASE and the Methodology Register of the Cochrane Library for studies that primarily aimed to examine the reporting quality of articles on diagnostic accuracy studies in humans by evaluating adherence to STARD. Study selection was performed in duplicate; data were extracted by one author and verified by the second author.
  
  
  RESULTS
  We included 16 studies, analysing 1496 articles in total. Three studies investigated adherence in a general sample of diagnostic accuracy studies; the others did so in a specific field of research. The overall mean number of items reported varied from 9.1 to 14.3 between 13 evaluations that evaluated all 25 STARD items. Six studies quantitatively compared post-STARD with pre-STARD articles. Combining these results in a random-effects meta-analysis revealed a modest but significant increase in adherence after STARD's introduction (mean difference 1.41 items (95% CI 0.65 to 2.18)).
  
  
  CONCLUSIONS
  The reporting quality of diagnostic accuracy studies was consistently moderate, at least through halfway the 2000s. Our results suggest a small improvement in the years after the introduction of STARD. Adherence to STARD should be further promoted among researchers, editors and peer reviewers.
authors.affiliation: Department of Clinical Epidemiology, Biostatistics and Bioinformatics (KEBB), Academic Medical Centre (AMC), University of Amsterdam (UvA), , Amsterdam, The Netherlands.
authors.forename: Daniël A
authors.initials: DA
authors.lastname: Korevaar
authors.forename: W Annefloor
authors.initials: WA
authors.lastname: van Enst
authors.forename: René
authors.initials: R
authors.lastname: Spijker
authors.forename: Patrick M M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: Lotty
authors.initials: L
authors.lastname: Hooft
mesh_terms: D057189:Checklist; D003955:Diagnostic Tests, Routine / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D017410:Practice Guidelines as Topic; D011786:Quality Control
keywords: Epidemiology