title: Inadequate critical appraisal of studies in systematic reviews of time to diagnosis.
abstract: To analyze tools used to critically appraise primary studies included in systematic reviews (SRs) of time to diagnosis (TTD).
  
  
  
  We systematically searched MEDLINE via PubMed and Web of Science for SRs of TTD published up to the end of February 2015; we identified and characterized tools used for critical appraisal and classified their items.
  
  
  
  From 1,936 articles identified, we included 45 SRs that aimed to summarize the available information on the length (n = 16), determinants (n = 31), and/or consequences (n = 14) of TTD. For the 23 SRs (51%) reporting a critical appraisal process, 21 different tools were used, with 232 items assessing quality of reporting (64%), risk of bias or threats to generalizability (43%), statistical issues (5%), and/or an unclear domain (0.5%); 11% were specific to TTD issues. Overall, 36% of the 45 SRs assessed risk of bias and/or threats to generalizability.
  
  
  
  Assessment of risk of bias and threats to generalizability in primary studies included in SRs of TTD is infrequent, nonstandardized and rarely concerns TTD study specificities. These findings highlight the need for guidance on critical appraisal of studies of TTD.
authors.affiliation: Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, 53 avenue de l'observatoire, 75014 Paris, France; CHU de Nantes, Hôpital Mère-Enfant, Services de pédiatrie générale et d'urgences pédiatriques, 7 quai Moncousu, 44000 Nantes, France. Electronic address: elise.launay@chu-nantes.fr.
authors.forename: Elise
authors.initials: E
authors.lastname: Launay
authors.affiliation: Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, 53 avenue de l'observatoire, 75014 Paris, France; Service de pédiatrie générale, Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, France; AP-HP, Paris, France; Université Paris Descartes, Paris, France.
authors.forename: Jérémie F
authors.initials: JF
authors.lastname: Cohen
authors.affiliation: Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, 53 avenue de l'observatoire, 75014 Paris, France; Service de pédiatrie générale, Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, France; AP-HP, Paris, France; Université Paris Descartes, Paris, France.
authors.forename: Michèle
authors.initials: M
authors.lastname: Morfouace
authors.affiliation: CHU de Nantes, Hôpital Mère-Enfant, Services de pédiatrie générale et d'urgences pédiatriques, 7 quai Moncousu, 44000 Nantes, France.
authors.forename: Christèle
authors.initials: C
authors.lastname: Gras-Le Guen
authors.affiliation: Inserm UMR 1153, METHODS Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, APHP, ​hôpital Hotel Dieu, 1 place du parvis Notre Dame, 75004 Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ravaud
authors.affiliation: Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, 53 avenue de l'observatoire, 75014 Paris, France; Service de pédiatrie générale, Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, France; AP-HP, Paris, France; Université Paris Descartes, Paris, France.
authors.forename: Martin
authors.initials: M
authors.lastname: Chalumeau
mesh_terms: D015982:Bias; D003627:Data Interpretation, Statistical; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D003933:Diagnosis; D042241:Early Diagnosis; D016021:Epidemiologic Studies; D006801:Humans; D012196:Review Literature as Topic; D013995:Time
keywords: Critical appraisal; Early diagnosis; Methodological quality; Risk of bias; Systematic review; Time to diagnosis