The conception of the PRISMA-DTA explanation, elaboration, and checklist document

During the first months of my master’s [epidemiology and public health] programme, I joined the Preferred Reporting Items for Systematic Review and Meta-analysis of Diagnostic Test Accuracy studies (PRISMA-DTA) group lead by my graduate supervisor, to participate in the development of the PRISMA-DTA checklist. [1] This extension of the traditional PRISMA checklist was needed to address the deficient reporting of diagnostic test accuracy (DTA) studies. [2]

Participating in this collective effort shed light on the dire need for an evaluation of the completeness of reporting of published DTA systematic reviews to help identify areas of deficiencies and strategies to improve transparent reporting. This inspired the main project of my master’s thesis, in which 100 reviews were included. [3] On average 71% of the items in PRISMA-DTA were reported, with the most frequently reported items pertaining to data-collection and statistical methods. Many study reports failed to mention whether they had been registered in a study registry, others lacked details regarding characteristics of the included studies, and the definitions used in data extraction, data synthesis, and results-synthesis. Additionally, we identified five items that were inadequately reported in our sample; these were items related to funding information, characteristics of included studies, strengths and limitations of the review, and the applicability of the findings. Since it is possible that the incomplete reporting of key items was due to a limited understanding of the arguments for including these items in the report, drafting an explanation and elaboration document became our new goal, as it would further assist researchers undertaking DTA systematic reviews to better grasp the rationale for reporting each item and provides them with examples of optimal practices and act as a pedagogical resource.

Insufficient reporting in DTA research could prevent stakeholders who place reliance on DTA systematic reviews from critically evaluating the quality of evidence and may consequently promote misallocation of resources. With the support of the PRISMA-DTA group, we wanted to highlight the rationale for transparent reporting in the evaluation of the review through providing examples and explanations. For instance, failure to report the intended use and clinical role of the index test (item D1) could prevent stakeholders and clinicians from clearly identifying whether the test is aimed for diagnostic, screening, staging or other purposes. Furthermore, reports that fail to provide the search strategy used to identify studies for inclusion (item 8) not only impede the successful replicability of the review, but also limit the readers’ ability to evaluate the comprehensiveness of the review. 

Improving reporting practices requires efforts to guide authors and stakeholders forward, while providing them with all the fundamental resources and guidance to succeed. This explanation and elaboration document, along with the PRISMA-DTA checklist are the first steps towards this goal, but additional steps will include an explanation and elaboration document for the PRISMA-DTA for Abstracts checklist.

Jean-Paul Salameh, methodologist, Ottawa Hospital Research Institute

Matthew DF McInnes, professor of radiology and epidemiology, Clinical Epidemiology Programme, Ottawa Hospital Research Institute

David Moher, senior scientist, Ottawa Hospital Research Institute Clinical Epidemiology Program

Brett D Tombs, professor of psychology, McGill University, Montréal

Patrick M. Bossuyt, professor of epidemiology, department of Clinical Epidemiology, University of Amsterdam

Competing interests statement: None declared


  1. McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, Clifford T, et al. Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies: The PRISMA-DTA Statement. JAMA. 2018;319(4):388-96.
  2. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.
  3. Salameh JP, McInnes MDF, Moher D, Thombs BD, McGrath TA, Frank R, et al. Completeness of Reporting of Systematic Reviews of Diagnostic Test Accuracy Based on the PRISMA-DTA Reporting Guideline. Clin Chem. 2019;65(2):291-301.