Evidence-based medicine, systematic reviews, and guidelines in interventional pain management: Part 7: systematic reviews and meta-analyses of diagnostic accuracy studies

Laxmaiah Manchikanti, Richard Derby, Lee Wolfer, Vijay Singh, Sukdeb Datta, Joshua A Hirsch
Pain Physician 2009, 12 (6): 929-63
Appropriate diagnosis is essential in providing proper and effective therapy. The field of diagnostic accuracy tests is dynamic with new tests being developed at a fast pace along with improvement in technology of existing tests on a continuous basis. Well-designed diagnostic test accuracy studies can help in making appropriate health care decisions, provided that they transparently and fully report their participants, tests, methods, and results. Exaggerated and biased results from poorly designed and reported diagnostic test studies can trigger their premature dissemination and lead physicians into making incorrect treatment decisions. Consequently, a diagnostic test is useful only to the extent that it distinguishes between conditions or disorders that might otherwise be confused. Since it is unlikely that clinicians, patients, and policy makers have the time, skills, and resources to find, appraise, and interpret the evidence and incorporate it into their health care decisions, systematic reviews and meta-analysis provide an accurate and reliable synthesis of vast quantities of data. A systematic review can identify what is known and what is unknown, giving guidance for future research. Systematic reviews have been considered as a vital link in the great chain of evidence that stretches from the laboratory to the bedside by helping to separate the insignificant, unsound, or redundant deadwood from the salient and critical studies that are worthy of reflection. A dangerous discrepancy exists between experts and evidence with all types of evidence. Historically, it has been reported that in only 15% of all cases can a pathoanatomical explanation be found for patients with chronic low back pain of more than 3 months resulting in the assumption that very little can be done in our present state of ignorance to treat these patients and improve their natural histories. On the other end of the spectrum, due to lack of sound diagnostic information, excessive health care is utilized with exploding costs. The validity of all diagnostic techniques has been described with variable accuracy and reliability. Lack of understanding of reference standards and their unavailability with interventional diagnostic techniques and misinterpretation secondary to interpretation bias may adversely influence the applicability of diagnostic interventions. This manuscript provides a review of the literature, a checklist, and a flow diagram describing the preferred way to present the abstract, introduction, methods, results, and discussion sections of the report of an analysis in a systematic review of diagnostic accuracy studies.

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