BackgroundAlthough guidelines for critical appraisal of diagnostic research and meta-analyses have already been published, these may be difficult to understand for clinical researchers or do not provide enough detailed information.MethodsDevelopment of guidelines based on a systematic review of the evidence in reports of systematic searches of the literature for diagnostic research, of methodological criteria to evaluate diagnostic research, of methods for statistical pooling of data on diagnostic accuracy, and of methods for exploring heterogeneity.ResultsGuidelines for conducting diagnostic systematic reviews are presented in a stepwise fashion and are followed by comments providing further information. Examples are given using the results of two systematic reviews on the accuracy of the urine dipstick in the diagnosis of urinary tract infections, and on the accuracy of the straight-leg-raising test in the diagnosis of intervertebral disc hernia.

Background: Many studies have evaluated the accuracy of dipstick tests as rapid detectors of bacteriuria and urinary tract infections (UTI). The lack of an adequate explanation for the heterogeneity of the dipstick accuracy stimulates an ongoing debate. The objective of the present meta-analysis was to summarise the available evidence on the diagnostic accuracy of the urine dipstick test, taking into account various pre-defined potential sources of heterogeneity.

Objective. To assess whether radiologic progression occurs during clinical remission in patients with rheumatoid arthritis (RA).Methods. One hundred eighty-seven patients with RA in clinical remission were followed up clinically and radiologically for 2 years. Clinical remission was defined according to a modification of the American College of Rheumatology criteria (i.e., the criterion of fatigue was omitted, and patients had to fulfill 4 of the 5 remaining criteria). Radiologic joint damage was assessed by the Sharp/van der Heijde method.Results. After 2 years of followup, remission persisted in 52% of patients. The median radiologic score for the total group of patients increased from 21 (interquartile range [IQR] 5, 65) at the time of entry to 25 (IQR 7, 72) after 2 years (P < 0.001). The median score for radiologic progression between baseline and 2 years was 0.5 (IQR 0, 2.5). Among patients with an exacerbation of RA (n ‫؍‬ 86), the median score for progression over 2 years was 1.0 (IQR 0, 4.5) (P < 0.001), and in patients with a persistent remission (n ‫؍‬ 93) it was 0 (IQR ؊0.5, 2.0) (P < 0.001). Clinically relevant progression of damage was more frequent in patients with exacerbation (23%) than in those with persistent remission (7%) (P ‫؍‬ 0.001). However, in 15% of patients with persistent remission, an erosion developed in a previously unaffected joint. In the logistic regression analysis, the area under the curve of the Disease Activity Score, a continuous measure, was related to the chance of radiologic progression, regardless of the absolute disease activity level. Results were similar when other definitions of remission were used. Conclusion. Although rare, clinically relevant progression of joint damage does occur in patients with RA in prolonged remission. This suggests the need for markers that predict progression during periods of low disease activity and for drugs that prevent damage that is independent of disease activity.

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The aim of this study was to aggregate the risk of traumatic dental injury due to overjet using several published papers and performing a meta-analysis on the results. The 11 articles involved in this investigation were identified by a literature search of Medline (1966-1996) and Exerpta Medica (1985-1996) databases using predetermined keywords, and inclusion and exclusion criteria. In order to assess the quality of each paper, a methodological checklist for observational studies was developed resulting in a score between 0 and 100. The relative risk of overjet, compared with a reference, was expressed as an Odds Ratio (OR). For each study, the OR was computed using the data presented and, subsequently, these ORs were pooled across studies. The effect of confounders (i.e. age, gender), which could bias the relationship between overjet and dental injury was taken into account. Furthermore, the influence of quality of the study on the pooled OR was addressed. The average methodological score was 41. From the results, it can be concluded that children with an overjet larger than 3 mm are approximately twice as much at risk of injury to anterior teeth than children with an overjet smaller than 3 mm. The effect of overjet on the risk of dental injury is less for boys than for girls in the same overjet group. In addition, risk of injury of anterior teeth tends to increase with increasing overjet size. Furthermore, the pooled OR does not seem to be affected by the quality of the studies.