Was there an appropriate interval between index test(s) and reference standard? Was a case control design avoided? If a threshold was used, was it pre- specified? Were the reference standard results interpreted without knowledge of the results of the index test? Did all patients receive a reference standard? Did the study avoid inappropriate exclusions? Did all patients receive the same reference standard? Were all patients included in the analysis? Risk of bias; (high/low/ unclear) Could the selection of patients have introduced bias? Could the conduct or interpretation of the index test have introduced bias? Could the reference standard, its conduct or its interpretation have introduced bias? Could the patient flow have introduced bias? Concerns regarding applicability (high/low/ unclear) Are there concerns that the included patients do not match the review question? Are there concerns that the index test, its conduct, or interpretation differ from the review question? Are there concerns that the target condition as defined by the reference standard does not match the review question? Inconsistency refers to an unexplained heterogeneity of results for an outcome across different studies. Inconsistency was assessed by inspection of the sensitivity and specificity (based on the primary measure) using the point estimates and 95% CIs of the individual studies on the forest plots. Particular attention was placed on values above or below 50% (diagnosis based on chance alone) and the threshold set by the committee (the threshold above which it would be acceptable to recommend a test). For example, the committee might have set a threshold of 90% as an acceptable level to recommend a test. 