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Published online before print June 27, 2005, 10.1148/radiol.2361040791
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Association between Compliance with Methodological Standards of Diagnostic Research and Reported Test Accuracy: Meta-Analysis of Focused Assessment of US for Trauma1

Dirk Stengel, MD, MSc, Kai Bauwens, MD, Grit Rademacher, MD, Sven Mutze, MD, PhD and Axel Ekkernkamp, MD, PhD

1 From the Clinical Epidemiology Division, Department of Orthopedic and Trauma Surgery (D.S., K.B., A.E.), and the Institute of Radiology (G.R., S.M.), Unfallkrankenhaus Berlin Trauma Center, Warener Str 7, 12683 Berlin, Germany. Received May 1, 2004; revision requested July 6; revision received July 9; accepted August 15. Address correspondence to D.S. (e-mail: dirk.stengel{at}ukb.de).



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  		Figure 1. Quality of Reporting Meta-analyses flowchart shows the study selection procedure.

 


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  		Figure 2. Graph shows assessment of publication bias with funnel plot asymmetry. Hasselblad diagnostic difference (d) represents a global measure of test accuracy. The shape of the plot was skewed, indicating a lack of small studies with small effect sizes.

 


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  		Figure 3. Assessment of heterogeneity with Galbraith diagrams. Note the scattering of sensitivity (left) compared with the homogeneous distribution of specificity (right).

 


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  		Figure 4. Summary receiver operating characteristics of FAST and FAST+ investigations. The scatterplot matrix and the summary receiver operating characteristic curves provide no evidence of a difference in test characteristics between both US protocols. The dotted line represents a test with no discriminatory ability.

 


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  		Figure 5. Graph shows significant decrease in the number of invasive procedures over time. Because of the wide distribution of CT frequencies across studies, we did not fit a regression line.

 


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  		Figure 6. Graph shows differences in receiver operating characteristics of US between pediatric and adult populations. Note the poorer test performance of US in children. The dotted line represents a test with no discriminatory ability.

 


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  		Figure 7. Graph shows the time-dependent decrease in reported US sensitivity was confounded by increasing methodologic quality. The regression line (with 95% confidence limits) was fitted between publication year and sensitivity estimates ({circ}). {bullet} = predictions adjusted for the number of methodologic standards.

 




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