Dissemination in diagnostic accuracy studies is not associated with methodological quality: a systematic review and meta-epidemiological analysis

OBJECTIVES: To evaluate associations between methodological characteristics and dissemination measures in diagnostic accuracy studies. The COVID-19 pandemic generated a large body of studies addressing a single diagnostic question, allowing assessment of how study characteristics relate to dissemination. STUDY DESIGN AND SETTING: Using a preregistered systematic review (PROSPERO CRD42023343656), we identified studies evaluating the diagnostic performance of SARS-CoV-2 serological tests through Medline, Embase, and the iSearch Portfolio. Risk of bias and applicability were assessed using QUADAS-2. Study characteristics were linked to dissemination measures, including journal impact factor, citation counts, network-based scientific influence (PageRank), and policy and guideline citations, using multivariable regression models. RESULTS: Among 18,092 screened records, 782 studies met the inclusion criteria. QUADAS-2 assessments varied substantially, with 772 of 782 studies (98.7%) exhibiting high or unclear risk of bias in at least one domain. Dissemination measures were positively associated with journal impact factor, earlier publication year, reporting of extreme diagnostic accuracy estimates, and higher last author H-index. In contrast, the number of domains rated as low risk of bias or high applicability was not positively associated with citation counts, network-based scientific influence, or policy citations. CONCLUSION: Dissemination was primarily associated with structural and authorship characteristics rather than QUADAS-2 ratings. These findings suggest that dissemination in diagnostic research is more closely linked to structural factors than assessed methodological quality and support strengthening diagnostic-specific approaches to evidence appraisal. PLAIN LANGUAGE SUMMARY: We examined whether high-quality diagnostic studies receive more attention in science and clinical practice. Using a large set of studies on COVID-19 antibody tests, we found that attention was mainly linked to factors such as the journal, publication timing, and authorship, rather than to methodological quality. Studies reporting very high accuracy also received more attention. This suggests that widely cited or highly visible studies are not necessarily the most reliable. Our findings highlight the need for careful evaluation of diagnostic studies and stronger emphasis on study quality when interpreting and using research results.