Creation and Critique of Studies of Diagnostic Accuracy: Use of the STARD and QUADAS Methodological Quality Assessment Tools

Clinical special tests are a mainstay of orthopaedic diagnosis. Within the context of the evidence-based practice paradigm, data on the diagnostic accuracy of these special tests are frequently used in the decision-making process when determining the diagnosis, prognosis, and selection of appropriate intervention strategies. However, the reported diagnostic utility of these tests is significantly affected by study methodology of diagnostic accuracy studies. Methodological shortcomings can influence the outcome of such studies, and this in turn will affect the clinician's interpretation of diagnostic findings. The methodological issues associated with studies investigating the diagnostic utility of clinical tests have mandated the development of the STARD (Standards for Reporting of Diagnostic Accuracy) and QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criterion lists. The purpose of this paper is to outline the STARD and QUADAS criterion lists and to discuss how these methodological quality assessment tools can assist the clinician in ascertaining clinically useful information from a diagnostic accuracy study.