a systematic review of high quality diagnostic tests for chagas disease系统回顾恰加斯病的高质量的诊断测试.pdfVIP

A Systematic Review of High Quality Diagnostic Tests for Chagas Disease 1 1 2 Anna M. Afonso *, Mark H. Ebell , Rick L. Tarleton 1 Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, United States of America, 2 Center for Tropical and Emerging Global Diseases and Department of Cellular Biology, University of Georgia, Athens, Georgia, United States of America Abstract Background: There is significant heterogeneity in reported sensitivities and specificities of diagnostic serological assays for Chagas disease, as might be expected from studies that vary widely according to setting, research design, antigens employed, and reference standard. The purpose of this study is to summarize the reported accuracy of serological assays and to identify sources of heterogeneity including quality of research design. To avoid associated spectrum bias, our analysis was limited to cohort studies. Methods: We completed a search of PubMed, a bibliographic review of potentially relevant articles, and a review of articles identified by a study author involved in this area of research. Studies were limited to prospective cohort studies of adults published since 1985. Measures of diagnostic accuracy were pooled using a Der Simonian Laird Random Effects Model. A subgroup analysis and meta regression were employed to identify sources of heterogeneity. The QUADAS tool was used to assess quality of included studies and Begg’s funnel plot was used to assess publication bias. Results: Eighteen studies and 61 assays were included in the final analysis. Significant heterogeneity was found in all pre- determined subgroups. Overall sensitivity was 90% (95% CI: 89%–91%) and overall specificity was 98% (95% CI: 98%–98%). Conclusion: Sensitivity and specificity of serologic