title: 'Cross hairs' plots for diagnostic meta-analysis.
abstract: Understanding diagnostic test accuracy (DTA) data, especially meta-analysis of this information, can be challenging for researchers and clinicians. The use of plots of receiver-operator curve (ROC) space showing individual studies and summary estimates of diagnostic accuracy has become common but can be difficult to interpret. The assessment of heterogeneity in sensitivity and specificity across studies can be particularly difficult. In this paper, we review the key concepts of assessing DTA, starting at the level of individual studies and progressing to the setting of research synthesis. We explore the standard displays of this information and then propose and explain an alternative approach to summarizing key data. These 'cross-hairs' plots display the individual studies in ROC space with paired confidence intervals representing sensitivity and specificity, and allow for the results of meta-analysis to be overlaid on the plot. We suggest that these plots are more easily interpreted, and are a more informative graphical form than common approaches. Copyright © 2011 John Wiley & Sons, Ltd.
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, YO10 5DD, U.K.. bob.phillips@york.ac.uk.
authors.forename: Bob
authors.initials: B
authors.lastname: Phillips
authors.affiliation: Department of Health Sciences, University of Leicester, 2nd Floor (Room 214e), Adrian Building, University Road, Leicester LE1 7RH, U.K.
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Stewart
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, YO10 5DD, U.K.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Sutton
keywords: clinical interpretation; diagnostic meta‐analysis; graphical display