Fast and frugal decision tree for the rapid critical appraisal of systematic reviews

Abstract

AbstractConducting high-quality overviews of reviews (OoR) is time-consuming. Because the quality of systematic reviews (SRs) varies, it is necessary to critically appraisal SRs when conducting an OoR. A well-established appraisal tool is AMSTAR 2, which takes about 15 to 32 minutes per application. To save time, we developed two fast-and-frugal decision trees (FFTs) for assessing the methodological quality of SR for OoR either during the full text screening stage (Screening FFT) or to the resulting pool of SRs (Rapid Appraisal FFT).To build a data set for developing the FFT, we identified published AMSTAR 2 appraisals. Overall confidence ratings of the AMSTAR 2 were used as criterion and the 16 items as cues.1,519 appraisals were obtained from 24 publications and divided into training and test data sets. The resulting Screening FFT consists of three items and correctly identifies all non-critically low-quality SRs (sensitivity of 100%), but a positive predictive value of 59%. The three-item Rapid Appraisal FFT correctly identifies 80% of the high-quality SRs and correctly identifies 97% of the low-quality SRs resulting in an accuracy of 95%. When applying the FFTs about 10% of the 16 AMSTAR 2 items are used.The Screening FFT may be applied during full text screening in order to exclude SRs with critically low quality. The Rapid Appraisal FFT may be applied to the final SR pool to identify SR that might be of high methodological quality.