High and unclear risk of bias assessments are predominant in diagnostic accuracy studies included in Cochrane reviews

Systematic reviews of diagnostic accuracy are based on studies with a majority of “high” or “unclear” bias assessments. The age of the articles explained only a small part of the variability of the score assessments, therefore not justifying an a priori exclusion of older articles in systematic reviews. There is an urgent need to improve the quality of design, conduct, and reporting of diagnostic accuracy studies.