QUADAS-2 · diagnostic accuracy

Risk-of-bias example: QUADAS-2 for diagnostic accuracy studies

QUADAS-2 risk-of-bias plots for ten diagnostic accuracy studies: patient selection, index test, reference standard, and flow and timing, with unclear judgements.

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Risk of bias domainsStudyD1D2D3D4OverallRuiz 2013×++?×Schmidt 2014+++++Tanaka 2015??++?Umar 2016+×++×Varga 2017++?+?Wang 2018×++××Xu 2019+++++Yilmaz 2020+?++?Zhou 2021+++??Abbas 2022++×+×Patient selection+?×Index test+?×Reference standard+?×Flow and timing+?×Overall risk ofbias+?×0%25%50%75%100%Share of studiesD1: Patient selectionD2: Index testD3: Reference standardD4: Flow and timingJudgement:+Low?Unclear×High
QUADAS-2 risk-of-bias judgements for ten diagnostic accuracy studies, with the unweighted summary. Illustrative data.

About this example

QUADAS-2 judges diagnostic accuracy studies in four domains. Unclear judgements are common because many primary studies do not report how patients were selected or whether the index test was read blind to the reference standard.

The unweighted summary plot shows the share of studies per judgement in each domain, which is the usual choice for diagnostic reviews, where studies are not pooled with inverse-variance weights. QUADAS-2 also rates applicability concerns; plot those as a second figure with “Other tool”.

The data

StudyPatient selectionIndex testReference standardFlow and timingOverall
Ruiz 2013HighLowLowUnclearHigh
Schmidt 2014LowLowLowLowLow
Tanaka 2015UnclearUnclearLowLowUnclear
Umar 2016LowHighLowLowHigh
Varga 2017LowLowUnclearLowUnclear
Wang 2018HighLowLowHighHigh
Xu 2019LowLowLowLowLow
Yilmaz 2020LowUnclearLowLowUnclear
Zhou 2021LowLowLowUnclearUnclear
Abbas 2022LowLowHighLowHigh

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