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Table 3 Studies that investigated subgroup variations*

From: A methodological framework to distinguish spectrum effects from spectrum biases and to assess diagnostic and screening test accuracy for patient populations: Application to the Papanicolaou cervical cancer smear test

Study, Year Approach to the analysis of spectrum bias/effect Disease (number of subjects) Diagnostic or screening test Factors investigated Effect on sensitivity and/or specificity Effect on Likelihood ratios
Van der schouw, 1995 [5] Subgroup analysis Epididymitis (372) Ultrasonography Disease prevalence (severity according to clinician) Disease prevalence (severity according to clinician) Disease prevalence (severity according to clinician)
Morise, 1995 [36] Subgroup analysis Coronary disease (4467) Exercise electrocardiography Sex Verification by the gold standard (angiography) or not Sex Verification bias by the gold standard (angiography) or not Not considered
O'Connor, 1996 [6] Subgroup analysis Multiple sclerosis (303) Magnetic resonance imaging and evoked potentials Study group (two pooled studies considered), disease prevalence, clinical subjective disease probability Study group, disease prevalence, clinical subjective disease probability Not considered
Egglin, 1996 [37] Subgroup analysis Pulmonary embolism (24) Pulmonary arteriogram Disease prevalence Disease prevalence Not considered
Roger, 1997 [8] Subgroup analysis Coronary disease (3679) Exercise echocardiography Sex Sex Not considered
Curtin, 1997 [7] Subgroup analysis Obesity (226) Body mass index Weight, sex Weight, sex Not considered
Moons, 1997 [9] Subgroup analysis and modelling of sensitivity Coronary disease (295) Exercise test Patient history and clinical examination, various disease-related factors (maximal load, relative load, systolic blood pressure, number of diseased vessels) Sex, expected load, maximal load, relative load, systolic blood pressure (baseline and peak), number of diseased vessels Age, sex, symptoms, smoking, beta blocker use, cholesterol level, expected load, maximal load, relative load, systolic blood pressure (baseline and peak)
Santana-Bodao, 1998 [38] Subgroup analysis Coronary disease (702) Single-photon emission computed tomography Sex Sex Not considered
Steinbauer, 1998 [10] Subgroup analysis Alcohol abuse (1333) Various screening tests Race and sex Race and sex Race and sex
DiMatteo, 2001 [39] Subgroup analysis Group A beta haemolytic streptococcal pharyngitis (498) Rapid antigen detection test Disease severity Disease severity Not considered
Filly, 2002 [48] Subgroup analysis and modelling Cirrhosis (100) Nodularity of surfaces of the liver Deep versus superficial surfaces Deep versus superficial surfaces Age, sex, pathological type of cirrhosis
Hall, 2004 [40] Subgroup analysis and modelling Group A beta haemolytic streptococcal pharyngitis (561) Rapid antigen detection test Disease severity Disease severity Not considered
Meideros, 2005 [49] Subgroup analysis Glaucoma (136) Scanning laser polarimetry Two forms of glaucomatous optic neuropathy Two forms of glaucomatous optic neuropathy Two forms of glaucomatous optic neuropathy
  1. * Papers published between 1978 and 2000 were identified from the systematic review by Whiting et al [14]. Papers published between 2000 and 2005 were similarly selected through Medline® using the keywords: diagnostic, test, screening, performance, accuracy, sensitivity, specificity, likelihood ratio, spectrum, subgroup, bias, prevalence, accuracy. Only primary studies investigating variations in diagnostic test performances between subgroups were considered. Letters were excluded.