Strengthening methods of diagnostic accuracy studies

To treat or not to treat? The decision to administer or withhold treatment based on test results could have far reaching effects on the health of a patient. The evidence supporting the accuracy of medical tests introduced in practice should therefore be credible and generated with valid and robust methods. In this thesis we assessed how recommended methods of diagnostic accuracy have been applied in primary studies and reviews of diagnostic test accuracy. We specifically focused on the methods of reporting of primary studies and on methods for assessing risk of bias, performing meta-analyses and investigating publication bias in systematic reviews of diagnostic test accuracy. This thesis shows that the uptake or correct use of these methods is suboptimal. This could be in part due to the complexity of diagnostic research and limited understanding of its methodology.