A Systematic Review of High Quality Diagnostic Tests for Chagas Disease 英文参考文献.docVIP

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A Systematic Review of High Quality Diagnostic Tests for Chagas Disease 英文参考文献.doc

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A Systematic Review of High Quality Diagnostic Tests for Chagas Disease 英文参考文献

ASystematicReviewofHighQualityDiagnosticTestsfor ChagasDisease AnnaM.Afonso1*,MarkH.Ebell1,RickL.Tarleton2 1DepartmentofEpidemiologyandBiostatistics,UniversityofGeorgia,Athens,Georgia,UnitedStatesofAmerica,2CenterforTropicalandEmergingGlobalDiseasesand DepartmentofCellularBiology,UniversityofGeorgia,Athens,Georgia,UnitedStatesofAmerica Abstract Background:Thereissignificantheterogeneityinreportedsensitivitiesandspecificitiesofdiagnosticserologicalassaysfor Chagas disease, as might be expected from studies that vary widely according to setting, research design, antigens employed,andreferencestandard.Thepurposeofthisstudyistosummarizethereportedaccuracyofserologicalassays and to identify sources of heterogeneity including quality of research design. To avoid associated spectrum bias, our analysiswaslimitedtocohortstudies. Methods:WecompletedasearchofPubMed,abibliographicreviewofpotentiallyrelevantarticles,andareviewofarticles identifiedbyastudyauthorinvolvedinthisareaofresearch.Studieswerelimitedtoprospectivecohortstudiesofadults publishedsince1985.MeasuresofdiagnosticaccuracywerepooledusingaDerSimonianLairdRandomEffectsModel.A subgroupanalysisandmetaregressionwereemployedtoidentifysourcesofheterogeneity.TheQUADAStoolwasusedto assessqualityofincludedstudiesandBegg’sfunnelplotwasusedtoassesspublicationbias. Results:Eighteenstudiesand61assayswereincludedinthefinalanalysis.Significantheterogeneitywasfoundinallpre- determinedsubgroups.Overallsensitivitywas90%(95%CI:89%–91%)andoverallspecificitywas98%(95%CI:98%–98%). Conclusion:SensitivityandspecificityofserologicalassaysforthediagnosisofChagasdiseaseappearlessaccuratethan previouslythought.Suggestionstoimprovetheaccuracyofreportingincludetheenrollmentofpatientsinaprospective manner,doubleblinding,andprovidinganexplicitmethodofaddressingsubjectsthathaveanindeterminatediagnosisby eitherthereferencestandardorindextest. Citation:AfonsoAM,EbellMH,TarletonRL(2012)ASystematicReviewofHighQualityDiagnosticTestsforChagasDisease.P