Response to QUADAS-2 tool for quality assessment in diagnostic meta-analysis

We are grateful for the comments on systematic review and meta-analysis by Dr. Huang and Huang (1). Quality Assessment of Diagnostic AccuracyStudies (QUADAS) is a currently recommended diagnostic accuracy trial quality evaluation tool adopted by Cochrane Library diagnosis trial system evaluation group. The group member revised QUADAS launched QUADAS-2 in 2011 (2,3). QUADAS-2 was composed mainly of 4 components, including case selection, the experiments to be evaluated, gold standard, and case process as well as progress (2,3). All components were performed with bias risk assessment. Besides, clinical applicability assessment was carried out for the first 3 components. Signature problems were included the bias risk assessment. The identification problems in the design of these studies were related to the potential for bias, which helped the evaluators to judge bias risk. There were no signature problems in the judgment of clinical applicability (4). The latest version should be selected for application and analysis in the research. Due to my negligence, I paid no attention to the updating of analysis software. As a result, QUADAS was still utilized in the research. The inconsistency between the cited literature and the contents of the text was a writing error. I was terribly sorry about that.

RevMan 5.3 was adopted to analyze the relevant data of the included articles. The software analysis usually utilized forest map and funnel plot to display the analysis results. Forest map clearly showed the research result of each article and the corresponding articles matching CI (5,6). It seemed that the analysis methods were introduced in data extraction and analysis sections. Actually, the analysis principle of RevMan 5.3 was introduced. Which articles could be included was explained and judged based on the influences of the included articles on the sensitivity and heterogeneity of the overall analysis results. In fact, it was still one part of data extraction. In terms of the problem of the basic information of articles and the basic characteristics of the subjects not being displayed in Tab. 1 of the original article, they were collected at the stage of data acquisition and extraction. However, future key points were also limited by the length of the article during result presentation. Therefore, some significant data showing great influences on the results of articles were selected and presented. During article retrieval, we did search for them in numerous databases. Due to the limitation of image size, the database called PubMed was shown in Fig. 1 of the original article without the supplement of “et al.”. I was really sorry about that.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Palliative Medicine. The article did not undergo external peer review.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-22-350/coif). The authors have no conflicts of interest to declare.

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References

1. Huang QX, Huang XW. QUADAS-2 tool for quality assessment in diagnostic meta-analysis. Ann Palliat Med 2022; [Crossref] [PubMed]
2. Yang B, Mallett S, Takwoingi Y, et al. QUADAS-C: A Tool for Assessing Risk of Bias in Comparative Diagnostic Accuracy Studies. Ann Intern Med 2021;174:1592-9. [Crossref] [PubMed]
3. Lin JS, Mustafa RA. Will QUADAS-C Make a Complicated Task Less Complex? Ann Intern Med 2021;174:1624-5. [Crossref] [PubMed]
4. Zwerus EL, Somford MP, Maissan F, et al. Physical examination of the elbow, what is the evidence? A systematic literature review. Br J Sports Med 2018;52:1253-60. [Crossref] [PubMed]
5. Zhang N, Fa T. A systematic review and meta-analysis of lifestyle nursing interventions for patients with cardiovascular disease. Ann Palliat Med 2021;10:10425-33. [Crossref] [PubMed]
6. Zuo Z, Yue J, Dong BR, et al. Thrombolytic therapy for pulmonary embolism. Cochrane Database Syst Rev 2021;4:CD004437. [PubMed]