Bias and applicability assessment
Assess verification and spectrum effects
Review selection, test interpretation, reference classification and participant timing together. An apparently precise estimate can remain biased or inapplicable to the intended setting. Record the version and scope of any appraisal tool used.
Flow diagram
Steps
Assess participant spectrum
Compare selection with the intended clinical setting.
Assess index-test bias
Evaluate thresholds, blinding and interpretation.
Assess reference and verification bias
Examine partial or differential verification and imperfect standards.
Assess timing and participant flow
Consider exclusions, missing tests and intervening treatment.
Plan sensitivity and applicability judgments
Document evidence supporting conclusions and limits.
Bias and applicability assessment
End flow
Tables and supporting information
Bias and applicability register
Leave study-specific judgments blank.