Diagnostic review overview — Systematic review of diagnostic test accuracy

Question through test evidence interpretation

Flow diagram

Steps

Clinical use question

Define the review question, intended decision and eligibility framework. Use PICO for intervention comparisons, PCC for scoping, or test/condition/clinical-role definitions for accuracy reviews.

Protocol and registration where applicable

Write the planned eligibility, search, selection, extraction, appraisal and synthesis methods before conducting the review. Record registration where eligible, or a public protocol location, and date subsequent amendments.

Search and select

Document reproducible searches and explicit screening decisions. Keep records, reports and studies distinct, with full-text exclusion reasons and study-to-report linkage.

Extract test data

Pilot fields, definitions and source-location capture. Verify important entries and retain study/report linkage. Use linked detailed flows for extraction and any associated appraisal.

Assess bias

Choose design-appropriate appraisal methods, record the tool version and assess relevant results with supporting evidence. Resolve judgments and use them in interpretation and sensitivity analyses.

Synthesize accuracy

Apply the prespecified synthesis strategy with documented deviations. Check compatibility, dependence and uncertainty; use structured synthesis when the intended pooling is not defensible.

Assess applicability

Compare included populations, tests, settings and reference standards with the intended clinical use. Explain where the findings may not transfer.

Report

Report methods, deviations, selection, findings and limitations using the relevant reporting guidance. Separate planned table shells from verified results and archive reproducible materials where permitted.