Eighteen diagnostic accuracy studies, with a total of 13,751 participants, were included in the review.
There was 94% agreement between reviewers for selection of studies (kappa statistic 0.87, 95% confidence interval, CI: 0.71, 0.94). Eleven studies were rated as level 1 evidence, five were rated as level 2 and two were rated as level 3.
Diagnosis of organic versus functional dyspepsia.
Based on the results of 4 studies, the pooled positive LR for primary care physicians was 1.3 (95% CI: 1.2, 1.4; heterogeneity, P=0.39) and the pooled negative LR was 0.66 (95% CI: 0.55, 0.79; heterogeneity, P=0.23). Based on the results of 5 studies, the pooled positive LR for specialists was 1.9 (95% CI: 1.5, 2.5; heterogeneity, P<0.001) and the negative LR was 0.40 (95% CI: 0.24, 0.66; heterogeneity, P=<0.001). Based on the results of 9 studies, the pooled positive LR for computer models was 1.6 (95% CI: 1.4, 1.9; heterogeneity, P=<0.001) and the negative LR was 0.45 (95% CI: 0.37, 0.55; heterogeneity, P=<0.001). When the primary care physician, specialist or computer assessed the patient as having organic dyspepsia, the pooled LR was 1.6 (95% CI: 1.4, 1.8). When the primary care physician, specialist or computer assessed the patient as having functional dyspepsia, the pooled LR was 0.46 (95% CI: 0.38, 0.55). The pooled DOR was 4.0 (95% CI: 2.8, 5.7; heterogeneity, chi-squared 190, P<0.001).
Diagnosis of peptic ulcer disease.
Based on 3 studies, the pooled positive LR for primary care physicians was 2.2 (95% CI: 1.8, 2.5; heterogeneity, P=0.95) and the negative LR was 0.63 (95% CI: 0.51, 0.79; heterogeneity, P=0.10). Based on 4 studies, the pooled positive LR for specialists was 2.9 (95% CI: 2.1, 4.0; heterogeneity, P<0.001) and the negative LR was 0.48 (95% CI: 0.43, 0.52; heterogeneity, P=0.72). Based on the results of 6 studies, the pooled positive LR for computer models was 1.9 (95% CI: 1.6, 2.3; heterogeneity, P<0.001) and the negative LR was 0.34 (95% CI: 0.25, 0.47; heterogeneity, P<0.001). When the results of all three methods of diagnosis were combined, the pooled positive LR was 2.2 (95% CI: 1.9, 2.6) and the negative LR was 0.45 (95% CI: 0.38, 0.53). The pooled DOR was 5.2 (95% CI: 0.38, 7.2; heterogeneity, chi-squared 56, P<0.001).
Diagnosis of oesophagitis.
Based on 4 studies, the pooled positive LR for primary care physicians was 2.3 (95% CI: 1.6, 3.2; heterogeneity, P<0.001) and the negative LR was 0.58 (95% CI: 0.43, 0.79). Based on 4 studies, the pooled positive LR for gastroenterologists was 4.5 (95% CI: 2.3, 8.9) and the negative LR was 0.48, (95% CI, 0.35, 0.65). Based on 7 studies, the pooled positive LR for computer models was 1.7 (95% CI: 1.5, 2.1) and the negative LR was 0.48 (95% CI: 0.36, 0.63). When the data for all three methods of diagnosis were combined, the pooled positive LR was 2.4 (95% CI: 1.9, 3.0) and the negative LR was 0.50 (95% CI: 0.42, 0.60). The pooled DOR for clinical opinion alone was 6.7 (95% CI: 3.7, 12.0; heterogeneity, chi-squared 76, P<0.001).