Cochrane Handbook for Systematic Reviews of Interventions
1.3.2 Reviews of diagnostic test accuracy

Cochrane has published systematic reviews of diagnostic test accuracy (DTA) in CDSR since 2008 (Leeflang 2013). These reviews evaluate how correctly a test detects the presence or absence of a target condition. Cochrane DTA reviews cover target conditions across health, including both pathologically defined diseases and more loosely defined indications for which treatments may be available. All types of tests are eligible, including: signs and symptoms from the patient history and examination; questionnaire-based tools, scores and decision rules; laboratory tests including biochemical, immunological, genetic, genomic and other ‘pan-omic’ technologies; imaging tests; and physiological measurements. Evaluation of the accuracy of a test is one component of the assessment of whether test use could lead to improvement in patient outcomes. Direct evaluation of how a test (and consequent decision-making and interventions) actually affect patient outcomes is best assessed by randomized studies that incorporate the effects of interventions that follow the test result. Such studies fit within the structure of Cochrane Intervention Reviews. However, randomized studies of test use are rare (especially outside the context of screening; Ferrante di Ruffano 2012), whereas accuracy studies are relatively common and provide most of the available evidence to guide test use, which makes them worthy of detailed systematic review.  Although the stages in a DTA review are the same as for reviews of interventions, specific methodological challenges are encountered at each step: from formulation of review questions, through searching for and locating studies, assessing study quality, meta-analysis and interpretation of findings. Full methodological details are described in a separate Cochrane Handbook for Diagnostic Test Accuracy Reviews (

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Change date
9 February 2017