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As readers of Evidence-Based Medicine, you are aware that systematic reviews are considered the best source of evidence for evidence-based clinical practice. Systematic reviews synthesise data from existing primary research and bring some order and sanity to the otherwise stressful process of sorting out a plethora of studies and staying up to date. However, since not all reviews are created equal, it is important to be able to critically assess their quality. In this editorial, we take you behind the scenes of a systematic review, using diagnostic test accuracy as an illustration. A clear understanding of the process will, hopefully, guide what you look for in a review. Furthermore, if you can’t find an existing diagnostic review and decide to do one yourself, we provide you with a “road map” (figure) for navigation.
STEPS IN THE SYSTEMATIC REVIEW PROCESS
Systematic reviews are done on a range of clinical questions, such as therapy, diagnosis, prognosis, aetiology, harm, and disease prevalence. All systematic reviews follow the same critical steps:
Formulation of the review question
A comprehensive, systematic search and selection of primary studies
Critical appraisal of included studies for quality and data extraction
Synthesis and summary of study results
Interpretation of the results
These steps resemble those of the evidence-based medicine (EBM) process, but are more thorough. In the EBM process, our objective is to quickly hunt down a valid source …