165 Cochrane study protocol: Accuracy of tubal patency tests 7 Indirect comparison As indirect comparisons are prone to bias, we will only perform them as additional analyses if there are limited studies for direct comparisons. In this case, we will include studies that include one or more index test. We will evaluate the comparative diagnostic accuracy between HSG and other tests. Procedure failure and adverse events We will tabulate procedure failure and adverse events for all index tests and the reference test. We will use Stata (38) and MetaDTA, an interactive online application for meta‐analysis of DTA studies (39). When necessary, we will also use Review Manager 5.4.1 (40). Investigations of heterogeneity We will consider the following in the assessments of heterogeneity. • Population characteristics: population risk stratification (high risk, low risk and unselected risk for tubal pathology). • Index tests characteristics: HSG (oil versus water based contrast media; operator skills), sono‐HSG (2D/3D versus 2D; different contrast media; use of colour doppler or not; operator skills), MR‐HSG (different viscosity contrast media), THL (operator skills). All these covariates are categorical variables. We will fit the models separately in different subgroups and perform visual inspections of SROC. Sensitivity analyses We will perform the following sensitivity analyses. • Different approaches to handling inconclusive results: ο treating valid inconclusive results as negative (i.e. patent); ο treating invalid inconclusive results are positive (occluded). • Limiting to studies at low risk of bias in the index tests and reference standard domains. Assessment of reporting bias We do not plan to evaluate reporting bias in this systematic review because statistical investigation of publication and reporting bias is not routinely recommended in DTA
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