A Meta-Analysis of Diagnostic Accuracy (Dollaghan & Homer, 2011)

Purpose To describe quality indicators for appraising studies of diagnostic accuracy and to report a meta-analysis of measures for diagnosing language impairment (LI) in bilingual Spanish–English U.S. children.

Method The authors searched electronically and by hand to locate peer-reviewed English-language publications meeting inclusion criteria; the authors rated quality features, calculated accuracy metrics and confidence intervals, and generated forest plots.

Results Of 771 citations (86 unique) located initially, accuracy metrics could be calculated for 17 index measures studied in a total of 100 children with LI and 109 with typical language. Most studies lacked clear descriptions of reference standards, procedures, and controls for subjective bias, making it difficult to rate specific quality features with confidence. Positive likelihood ratios (LR+) for most measures were at least diagnostically suggestive (pooled LR+ = 4.12; 95% CI [2.94, 5.78]). Negative likelihood ratios (LR?) were also generally suggestive, but heterogeneity precluded averaging. For every measure, confidence intervals for LR+ and LR? included diagnostically uninformative values.

Conclusions The available evidence does not support strong claims concerning the diagnostic accuracy of these measures, but a number appear promising. Several steps are suggested for strengthening future investigations of diagnostic accuracy.

目的：本数据集旨在阐述评估诊断准确性研究的质量指标，并报告针对诊断双语西班牙语-英语美国儿童的言语障碍（LI）的度量方法的荟萃分析。
方法：作者通过电子检索和手工检索寻找符合纳入标准的同行评审的英文出版物；作者评估了质量特征，计算了准确性指标和置信区间，并生成了森林图。
结果：在最初找到的771篇参考文献（86篇独特）中，可以计算17个研究指数的准确性指标，涉及100名言语障碍儿童和109名典型语言儿童。大多数研究缺乏对参考标准、程序和控制主观偏差的明确描述，这使得难以自信地评估特定的质量特征。大多数指标的阳性似然比（LR+）至少具有诊断上的提示意义（合并LR+ = 4.12；95% CI [2.94, 5.78]）。阴性似然比（LR?）也通常具有提示意义，但异质性排除了平均化的可能性。对于每个指标，LR+和LR?的置信区间包括了诊断上无信息的值。
结论：现有证据不支持对这些措施的诊断准确性做出强烈的主张，但其中一些看起来很有希望。为加强未来对诊断准确性的研究，提出了一些建议。