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Article ; Online: Tutorial: statistical methods for the meta-analysis of diagnostic test accuracy studies.

Schlattmann, Peter

Clinical chemistry and laboratory medicine

2023 Volume 61, Issue 5, Page(s) 777–794

Abstract: This tutorial shows how to perform a meta-analysis of diagnostic test accuracy studies (DTA) based on a 2 × 2 table available for each included primary study. First, univariate methods for meta-analysis of sensitivity and specificity are presented. Then ... ...

Abstract	This tutorial shows how to perform a meta-analysis of diagnostic test accuracy studies (DTA) based on a 2 × 2 table available for each included primary study. First, univariate methods for meta-analysis of sensitivity and specificity are presented. Then the use of univariate logistic regression models with and without random effects for e.g. sensitivity is described. Diagnostic odds ratios (DOR) are then introduced to combine sensitivity and specificity into one single measure and to assess publication bias. Finally, bivariate random effects models using the exact binomial likelihood to describe within-study variability and a normal distribution to describe between-study variability are presented as the method of choice. Based on this model summary receiver operating characteristic (sROC) curves are constructed using a regression model logit-true positive rate (TPR) over logit-false positive rate (FPR). Also it is demonstrated how to perform the necessary calculations with the freely available software R. As an example a meta-analysis of DTA studies using Procalcitonin as a diagnostic marker for sepsis is presented.
MeSH term(s)	Humans ; Diagnostic Tests, Routine ; Procalcitonin ; ROC Curve ; Sensitivity and Specificity ; Sepsis/diagnosis ; Meta-Analysis as Topic
Chemical Substances	Procalcitonin
Language	English
Publishing date	2023-01-19
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	1418007-8
ISSN	1437-4331 ; 1434-6621 ; 1437-8523
ISSN (online)	1437-4331
ISSN	1434-6621 ; 1437-8523
DOI	10.1515/cclm-2022-1256
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Article ; Online: Statistics in diagnostic medicine.

Schlattmann, Peter

Clinical chemistry and laboratory medicine

2022 Volume 60, Issue 6, Page(s) 801–807

Abstract: This tutorial gives an introduction into statistical methods for diagnostic medicine. The validity of a diagnostic test can be assessed using sensitivity and specificity which are defined for a binary diagnostic test with known reference or gold standard. ...

Abstract	This tutorial gives an introduction into statistical methods for diagnostic medicine. The validity of a diagnostic test can be assessed using sensitivity and specificity which are defined for a binary diagnostic test with known reference or gold standard. As an example we use Procalcitonin with a cut off value ≥ 0.5 g/L as a test and Sepsis-2 criteria as a reference standard for the diagnosis of sepsis. Next likelihood ratios are introduced which combine the information given by sensitivity and specificity. For these measures the construction of confidence intervals is demonstrated. Then, we introduce predictive values using Bayes' theorem. Predictive values are sometimes difficult to communicate. This can be improved using natural frequencies which are applied to our example. Procalcitonin is actually a continuous biomarker, hence we introduce the use of receiver operator curves (ROC) and the area under the curve (AUC). Finally we discuss sample size estimation for diagnostic studies. In order to show how to apply these concepts in practice we explain how to use the freely available software R.
MeSH term(s)	Bayes Theorem ; Humans ; Procalcitonin ; ROC Curve ; Sensitivity and Specificity ; Sepsis/diagnosis
Chemical Substances	Procalcitonin
Language	English
Publishing date	2022-03-31
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	1418007-8
ISSN	1437-4331 ; 1434-6621 ; 1437-8523
ISSN (online)	1437-4331
ISSN	1434-6621 ; 1437-8523
DOI	10.1515/cclm-2022-0225
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Article ; Online: Die adaptive Messung des Freiburger Einsilbertests im Störschall mit einer verringerten Anzahl an Testlisten.

Memmeler, Tobias / Schönweiler, Rainer / Schlattmann, Peter / Löhler, Jan

Laryngo- rhino- otologie

2024

Abstract: Background: Considering the different calibration and masking of the noise, the adaptive Freiburg monosyllabic speech test in noise (aFBE-S) and the Oldenburg sentence test in noise (OLSA-S) were shown to be comparable with respect to the accuracy of ... ...

Title translation	The adaptive use of the Freiburg mono-syllabic speech test in noise with a few number of test-lists.
Abstract	Background: Considering the different calibration and masking of the noise, the adaptive Freiburg monosyllabic speech test in noise (aFBE-S) and the Oldenburg sentence test in noise (OLSA-S) were shown to be comparable with respect to the accuracy of both tests in a previous study. However, the time requirement of the aFBE-S was significantly greater than that of the OLSA-S due to the adaptive measurement method. The purpose of this study is to theoretically determine whether the aFBE-S can be used with fewer test lists, given the low scatter of results, and to compare the results with those of the OLSA-S. Methods: Using the results of 40 otologically healthy subjects who had already been tested in randomized order with the OLSA-S and aFBE-S, the mean difference of the 95 % confidence interval (95 % CI) of the signal-to-noise ratio for 50% speech understanding (S/N50) of the aFBE-S was calculated for three, four, and five test lists instead of 7.5. In addition, the time required for the reduced number of test lists was determined and the results were examined in comparison with those of the OLSA-S. Results: In each case, no significant difference between the difference mean of the 95 %-CI of the S/N50 of the original aFBE-S, the aFBE-S shortened to 3, 4, or 5 test lists and the OLSA-S could be found. The time required for the aFBE-S with a reduced number of test lists was significantly less than for the OLSA-S in each case. Conclusion: The aFBE-S is not inferior with a reduced number of test lists in comparison to the OLSA-S. This would allow to use the shortened aFBE-S theoretically.
Language	German
Publishing date	2024-02-22
Publishing country	Germany
Document type	English Abstract ; Journal Article
ZDB-ID	96005-6
ISSN	1438-8685 ; 0340-1588 ; 0935-8943
ISSN (online)	1438-8685
ISSN	0340-1588 ; 0935-8943
DOI	10.1055/a-2235-0873
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Article ; Online: Contribution to the discussion of "When should meta-analysis avoid making hidden normality assumptions?"

Schlattmann, Peter

Biometrical journal. Biometrische Zeitschrift

2018 Volume 60, Issue 6, Page(s) 1089–1090

MeSH term(s)	Health ; Models, Statistical ; Normal Distribution
Language	English
Publishing date	2018-08-07
Publishing country	Germany
Document type	Journal Article ; Comment
ZDB-ID	131640-0
ISSN	1521-4036 ; 0323-3847 ; 0006-3452
ISSN (online)	1521-4036
ISSN	0323-3847 ; 0006-3452
DOI	10.1002/bimj.201800194
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Book ; Thesis: Medical applications of finite mixture models

Schlattmann, Peter

(Statistics for biology and health)

2009

Author's details	Peter Schlattmann
Series title	Statistics for biology and health
Keywords	Data Interpretation, Statistical ; Models, Statistical ; Meta-Analysis as Topic ; Medizinische Statistik ; Heterogenität ; Statistisches Modell ; Zusammengesetzte Verteilung
Subject	Mischverteilung ; Mixture distribution ; Compound distribution ; Mixed distribution ; Statistik ; Inhomogenität ; Verschiedenartigkeit ; Uneinheitlichkeit
Language	English
Size	X, 246 S. : graph. Darst.
Publisher	Springer
Publishing place	Berlin u.a.
Publishing country	Germany
Document type	Book ; Thesis
Thesis / German Habilitation thesis	Berlin, Univ.-Medizin, Habil.-Schr., 2008
HBZ-ID	HT015562018
ISBN	978-3-540-68650-7 ; 9783540686514 ; 3-540-68650-9 ; 3540686517
Database	Catalogue ZB MED Medicine, Health

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2009 A 3944	order for loan	Magazin

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Article ; Online: Surgery for patients with facial palsy in Germany: a diagnosis-related-groups-based nationwide analysis, 2005-2019.

Seeberger, Susanna / Schlattmann, Peter / Guntinas-Lichius, Orlando

European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

2023 Volume 281, Issue 1, Page(s) 451–459

Abstract: Purpose: Chronic flaccid paralysis of the facial nerve leads to permanent dysfunction of eye closure, problems with drinking and eating, and lack of emotional expression. Modern facial surgery can help those affected. An analysis of the development of ... ...

Abstract	Purpose: Chronic flaccid paralysis of the facial nerve leads to permanent dysfunction of eye closure, problems with drinking and eating, and lack of emotional expression. Modern facial surgery can help those affected. An analysis of the development of facial surgery in Germany over time is presented. Methods: Nation-wide population-baes diagnosis-related case group (DRG) data of virtually all inpatients who underwent facial surgery for facial palsy between 2005 and 2019 were included. Binomial regression models for changes in surgery rates over time were calculated in relation to gender and treating specialty. Results: Between 2005 and 2019, there were 28,622 inpatient stays for facial surgery. Most surgeries were provided by otolaryngology (39%) and ophthalmology or dentistry, oral and maxillofacial surgery (20% each). The mean treatment rate was 2.33 ± 0.53 surgeries per 100,000 person-years. The surgery rate was highest for nerve reconstruction surgery (0.46 ± 0.15) and static sling surgery (0.44 ± 0.0.16). The greatest increase was seen in men for nerve surgery (3.9-fold; relative risk [RR] = 3.68; confidence interval [CI] = 3.18-4.26) and sling surgery (5.0-fold; RR = 4.25; CI = 3.38-5.33). Conclusions: While nerve and sling surgery increased significantly over time, this was less true or not true at all for surgical techniques. Surgical rates and their change over time were greater in men, without explanation from the data.
MeSH term(s)	Male ; Humans ; Female ; Facial Paralysis/epidemiology ; Facial Paralysis/surgery ; Bell Palsy ; Facial Nerve/surgery ; Face ; Nerve Transfer/methods ; Germany/epidemiology
Language	English
Publishing date	2023-09-27
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1017359-6
ISSN	1434-4726 ; 0937-4477
ISSN (online)	1434-4726
ISSN	0937-4477
DOI	10.1007/s00405-023-08259-4
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Article: Die adaptive Messung des Freiburger Einsilbertests im Störschall mit einer verringerten Anzahl an Testlisten

Memmeler, Tobias / Schönweiler, Rainer / Schlattmann, Peter / Löhler, Jan

Laryngo-Rhino-Otologie

2024

Abstract: Hintergrund: Berücksichtigt man die unterschiedliche Kalibrierung und Verdeckung des Störschalls, waren der adaptive Freiburger Einsilbertest im Störschall (aFBE-S) und der Oldenburger Satztest im Störschall (OLSA-S) bezüglich der Genauigkeit beider ... ...

Abstract	Hintergrund: Berücksichtigt man die unterschiedliche Kalibrierung und Verdeckung des Störschalls, waren der adaptive Freiburger Einsilbertest im Störschall (aFBE-S) und der Oldenburger Satztest im Störschall (OLSA-S) bezüglich der Genauigkeit beider Tests in einer vorherigen Untersuchung vergleichbar. Allerdings war der Zeitbedarf des aFBE-S durch die adaptive Messweise größer als beim OLSA-S. In dieser Studie soll theoretisch ermittelt werden, ob der aFBE-S auch mit weniger Testlisten angewendet werden kann; die Ergebnisse werden mit denen des OLSA-S verglichen. Methoden: Anhand der Ergebnisse von 40 otologisch gesunden Probanden, welche bereits in randomisierter Reihenfolge mit dem OLSA-S und aFBE-S getestet wurden, erfolgte der Vergleich der Mittelwertdifferenzen der 95%-Konfidenzintervalle für eine bestimmte Anzahl an Testlisten des aFBE-S und des OLSA-S. Der mittlere Signal-Rausch-Abstand für das 50%-Sprachverstehen (S/N50) des aFBE-S wurde für 3, 4 und 5 anstatt 7,5 Testlisten berechnet. Zudem wurde der Zeitbedarf für die verringerte Anzahl an Testlisten ermittelt und die Ergebnisse im Vergleich mit denen des OLSA-S untersucht. Ergebnisse: Es konnte jeweils kein signifikanter Unterschied der Mittelwertdifferenzen der Konfidenzintervalle zwischen den S/N50 des originalen aFBE-S, des auf 3, 4 oder 5 Testlisten verkürzten aFBE-S und des OLSA-S nachgewiesen werden. Der Zeitbedarf des verkürzten aFBE-S war jeweils signifikant geringer als für den OLSA-S. Schlussfolgerung: Der aFBE-S ist theoretisch auch mit einer verringerten Anzahl an Testlisten möglich und dem OLSA-S dabei nicht unterlegen. Dadurch ließe sich der verkürzte aFBE-S bis zu 5-mal anwenden, ohne dass sich die Testlisten wiederholen. Es bedarf jedoch einer praktischen Überprüfung der berechneten Ergebnisse.
Keywords	Sprachaudiometrie ; Freiburger Einsilbertest ; Oldenburger Satztest ; Sprachverstehenstest ; adaptive Messung ; Sprachaudiometrie im Störgeräusch ; Freiburger Einsilbertest im Störgeräusch ; speech audiometry ; Freiburg mono-syllabic speech-test ; Oldenburg sentence test ; speech discrimination test ; speech discrimination test in noise ; Freiburg mono-syllabic speech-test in noise
Language	German
Publishing date	2024-02-22
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	96005-6
ISSN	1438-8685 ; 0935-8943 ; 0340-1588
ISSN (online)	1438-8685
ISSN	0935-8943 ; 0340-1588
DOI	10.1055/a-2235-0873
Database	Thieme publisher's database

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Article ; Online: An exemplary reanalysis of coronary computed tomography angiography diagnostic meta-analyses shows insufficient data sharing and incorrect sensitivity and specificity estimates.

Vogelgesang, Felicitas / Coenen, Maria H / Schueler, Sabine / Schlattmann, Peter / Dewey, Marc

Journal of clinical epidemiology

2024 Volume 170, Page(s) 111306

Abstract: Objectives: To systematically evaluate the reproducibility of primary data and, the reproducibility and correctness of pooled sensitivity and specificity estimates reported in a sample of diagnostic meta-analyses.: Study design and setting: We ... ...

Abstract	Objectives: To systematically evaluate the reproducibility of primary data and, the reproducibility and correctness of pooled sensitivity and specificity estimates reported in a sample of diagnostic meta-analyses. Study design and setting: We conducted an exemplary systematic review of diagnostic meta-analyses comparing coronary computed tomography angiography to invasive coronary angiography in patients with suspected coronary artery disease. The objectives were to assess 1) the reproducibility of contingency tables, 2) the reproducibility of pooled sensitivity and specificity, and 3) differences to reported results when applying a recommended bivariate binomial model for pooling sensitivity and specificity. Therefore, we reproduced the contingency tables and recalculated sensitivity and specificity by utilizing both the pooling method of each meta-analysis and a bivariate binomial model. We used linear trends to assess the improvement of these objectives over time. Results: We identified 38 diagnostic meta-analyses, each including on average 19 primary studies (range: 3 to 89 studies; total: 715-including duplicates) with an average of approximately 1800 patients per meta-analysis (range: 118 to 7516 patients). For 31 meta-analyses (82%, 95% CI: 65%, 91%), the contingency tables were reproducible; however, only 15 published them. Using the pooling method of each meta-analysis, we obtained comparable recalculated sensitivities/specificities for 28 meta-analyses (74% [57%, 86%]). Only 11 meta-analyses pooled sensitivity/specificity using a bivariate binomial model (29% [16%, 46%]). When all meta-analyses were pooled with this model, published sensitivities/specificities were confirmed for 19 of 38 meta-analyses (50% [34%, 66%]). There was only marginal improvement in data availability and application of recommended pooling methods over time. Conclusion: Data sharing should become standard practice along with the use of appropriate pooling methods. Journal publication requirements may play a key role in enhancing the quality of scientific reporting and methodological standards which may lead to more reliable and consistent outcomes. The ability to reproduce sensitivity and specificity estimates in diagnostic imaging meta-analyses is dependent on the availability of contingency tables and the explicit reporting of pooling methods and software used.
Language	English
Publishing date	2024-02-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	639306-8
ISSN	1878-5921 ; 0895-4356
ISSN (online)	1878-5921
ISSN	0895-4356
DOI	10.1016/j.jclinepi.2024.111306
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Article: The Association between Patient's Age and Head and Neck Cancer Treatment Decision-A Population-Based Diagnoses-Related Group-Based Nationwide Study in Germany.

Kouka, Mussab / Hermanns, Isabel / Schlattmann, Peter / Guntinas-Lichius, Orlando

Cancers

2023 Volume 15, Issue 6

Abstract: Investigations on the association between patient's age and head and neck cancer (HNC) treatment decision are sparse. Nationwide diagnoses-related group-based data of 1,226,357 cases hospitalized with primary HNC in Germany from 2005 to 2018 were ... ...

Abstract	Investigations on the association between patient's age and head and neck cancer (HNC) treatment decision are sparse. Nationwide diagnoses-related group-based data of 1,226,357 cases hospitalized with primary HNC in Germany from 2005 to 2018 were included. Negative binomial regression was performed to study the development of the treatment rates over time. For all treatment options, i.e., biopsies, surgery, radiotherapy, and chemotherapy/biologicals, increases in the treatment rates were seen in patients >80 years (surgery: oral cavity: relative risk [RR]: 1.2, CI: 1.13-1.20; oropharynx: RR: 1.2, CI: 1.15-1.34; hypopharynx: RR: 1.1, CI: 1.02-1.17; larynx: RR: 1.1, CI: 1.04-1.12; radiotherapy: oral cavity: RR: 1.1, CI: 1.07-1.23; oropharynx: RR: 1.3, CI: 1.16-1.49; hypopharynx: RR: 1.3, CI: 1.21-1.46; larynx: RR 1.2, CI: 1.03-1.29; chemotherapy: oral cavity: RR: 1.2, CI: 1.06-1.31; salivary glands: RR: 1.3, CI: 1.09-1.50; oropharynx: RR: 1.4, CI: 1.12-1.83; hypopharynx: RR: 1.3, CI: 1.06-1.48; larynx: RR: 1.3, CI: 1.08-1.52, all
Language	English
Publishing date	2023-03-15
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15061780
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Article: Surgery for bilateral vocal fold paralysis: Systematic review and meta-analysis.

Titulaer, Kai / Schlattmann, Peter / Guntinas-Lichius, Orlando

Frontiers in surgery

2022 Volume 9, Page(s) 956338

Abstract: Objectives: To determine the decannulation rate (DR) and revision surgery rate after surgery for bilateral vocal fold paralysis (BVFP).: Data sources: Five databases (MEDLINE, PubMed, Embase, Web of Science, Scopus) were searched for the period 1908- ... ...

Abstract	Objectives: To determine the decannulation rate (DR) and revision surgery rate after surgery for bilateral vocal fold paralysis (BVFP). Data sources: Five databases (MEDLINE, PubMed, Embase, Web of Science, Scopus) were searched for the period 1908-2020. Methods: The systematic literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were pooled using a random-mixed-effects model. Randomized controlled trials and non-randomized studies (case-control, cohort, and case series) were included to assess DR and revision surgery rate after different surgical techniques for treatment of BVFP. Results: The search yielded 857 publications, of which 102 with 2802 patients were included. DR after different types of surgery was: arytenoid abduction (DR 0.93, 95%-confidence interval [CI], 0.86-0.97), endolaryngeal arytenoidectomy (DR 0.92, 95%-CI, 0.86-0.96), external arytenoidectomy (DR 0.94; 95%-CI, 0.71-0.99), external arytenoidectomy and lateralisation (DR 0.87; 95%-CI, 0.73-0.94), laterofixation (DR 0.95; 95%-CI, 0.91-0.97), posterior cordectomy (DR 0.97, 95%-CI, 0.94-0.99), posterior cordectomy and arytenoidectomy (DR 0.98, 95%-CI, 0.93-0.99), posterior cordectomy and subtotal arytenoidectomy (DR 0.98, 95%-CI, 0.88-1.00), posterior cordotomy (DR 0.96, 95%-CI, 0.84-0.99), reinnervation (0.69, 95%-CI, 0.12-0.97), subtotal arytenoidectomy (DR 1.00, 95%-CI, 0.00-1.00) and transverse cordotomy (DR 1.0, 95%-CI, 0.00-1.00). No significant difference between subgroups for DR could be found (Q = 15.67, df = 11, Conclusion: BLVP is a rare disease and the study quality is insufficient. The existing studies suggest a publication bias and the literature review revealed that there is a lack of prospective controlled studies. There is a lack of standardized measures that takes into account both speech quality and respiratory function and allows adequate comparison of surgical methods.
Language	English
Publishing date	2022-07-22
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2022.956338
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