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The second domain relates to bias that could be introduced by the Index test (blinding when interpreting the index test, clear description of the diagnostic thresholds).
All the included studies fulfilled the requirements of acceptable reference standard, partial verification bias avoided, differential verification bias avoided, incorporation bias avoided, detailed description of index test, blinding of investigators to reference, uninterpretable results reported and withdrawals explained.
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In gynaecology however, there were some items that showed poorer reporting post STARD such as description of cut-off of index test and blinding.
In four of the eight studies, it was unclear if the assessor of the index test was blinded for the results of the reference test and/or clinical diagnosis.
Assessment of the index test was blinded (without knowledge of the reference standard) in 15 (68 %) studies.
In only 19% of gynaecology studies was the index test interpretation blind, reflecting the nature of the tests assessed in these reviews.
The major biases of the included studies fell in the domains of "representative spectrum," "index test results blinded," and "relevant clinical information".
In the domain of "index test results blinded," all studies reported the diagnostic standard for HCC; however, no studies have stated whether the index results were blindly interpreted or not.
We undertook sensitivity analyses by limiting inclusion in the meta-analyses to: studies with consecutive or random selection of samples, studies with cross-sectional design, studies where index test results were blinded to reference standard results, and studies where reference standard results were blinded to index test results.
The index test results were blinded in 18% of the studies.
This checklist has 5 major parts as follows: representative spectrum of the patients, consecutive patient recruitment, ascertainment of the gold standard regardless of the index test results, independent blind comparison between the gold standard and index test results, and enough explanation of the test to permit replication.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com