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Methodological quality of diagnostic accuracy studies on non-invasive coronary CT angiography: influence of QUADAS (Quality Assessment of Diagnostic Accuracy Studies included in systematic reviews) items on sensitivity and specificity

  • Computed Tomography
  • Published:
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Abstract

Objectives

To evaluate the methodological quality of diagnostic accuracy studies on coronary computed tomography (CT) angiography using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies included in systematic reviews) tool.

Methods

Each QUADAS item was individually defined to adapt it to the special requirements of studies on coronary CT angiography. Two independent investigators analysed 118 studies using 12 QUADAS items. Meta-regression and pooled analyses were performed to identify possible effects of methodological quality items on estimates of diagnostic accuracy.

Results

The overall methodological quality of coronary CT studies was merely moderate. They fulfilled a median of 7.5 out of 12 items. Only 9 of the 118 studies fulfilled more than 75 % of possible QUADAS items. One QUADAS item (“Uninterpretable Results”) showed a significant influence (P = 0.02) on estimates of diagnostic accuracy with “no fulfilment” increasing specificity from 86 to 90 %. Furthermore, pooled analysis revealed that each QUADAS item that is not fulfilled has the potential to change estimates of diagnostic accuracy.

Conclusions

The methodological quality of studies investigating the diagnostic accuracy of non-invasive coronary CT is only moderate and was found to affect the sensitivity and specificity. An improvement is highly desirable because good methodology is crucial for adequately assessing imaging technologies.

Key Points

• Good methodological quality is a basic requirement in diagnostic accuracy studies.

• Most coronary CT angiography studies have only been of moderate design quality.

• Weak methodological quality will affect the sensitivity and specificity.

• No improvement in methodological quality was observed over time.

• Authors should consider the QUADAS checklist when undertaking accuracy studies.

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Acknowledgments

Supported by the Joint programme of the German Research Foundation (DFG) and the German Federal Ministry of Education and Research (BMBF) for meta-analyses (01KG1013, 01KG1110).

A pool of 88 studies were obtained from a former investigation of our working group (Schuetz et al., Ann Intern Med, 2010) and additionally 30 studies were retrieved by a systematic search update.

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Authors and Affiliations

  1. Charité Medical School, Department of Radiology, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany

    Sabine Schueler, Stefan Walther, Georg M. Schuetz & Marc Dewey

  2. Department of Medical Statistics, Informatics, and Documentation, University Hospital of Friedrich Schiller University Jena, Jena, Germany

    Peter Schlattmann

  3. Charité, Institut für Radiologie, Charitéplatz 1, 10117, Berlin, Germany

    Marc Dewey

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  1. Sabine Schueler
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  2. Stefan Walther
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  3. Georg M. Schuetz
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  5. Marc Dewey
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Correspondence to Marc Dewey.

Appendix

Appendix

Table 6 Consensus reviewers’ judgement for all QUADAS items and summary of assessments
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Schueler, S., Walther, S., Schuetz, G.M. et al. Methodological quality of diagnostic accuracy studies on non-invasive coronary CT angiography: influence of QUADAS (Quality Assessment of Diagnostic Accuracy Studies included in systematic reviews) items on sensitivity and specificity. Eur Radiol 23, 1603–1622 (2013). https://doi.org/10.1007/s00330-012-2763-0

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