Test Evaluation Research Group (TERG)

TERG undertakes both methods and applied health research. We are involved in many international collaborations and lead several collaborations working to set standards for design, delivery and analysis of studies of diagnostic tests. Our main areas of research include:

• Primary studies of diagnostic test accuracy

The TERG team have a broad portfolio of expertise in planning, delivery and analysis of primary studies designed to assess the use of tests in healthcare.

• Systematic review of diagnostic test accuracy

TERG is also recognised for it work in the field of systematic reviews and meta-analysis of diagnostic test evaluation. We work closely with the Cochrane Screening and Diagnostic Tests Methods Group providing the editorial base for systematic reviews of diagnostic test accuracy in the Cochrane Library.

• Estimating technical properties of biomarkers

Our team has expertise in design and analysis of biological variability and interobserver variability studies. We are developing methodological guidance in this area through our work with the NIHR Birmingham Biomedical Research Centre.

• Ensuring test evaluations are fit-for-purpose

Other areas of methodological innovation include developing theory and practical applications for assessing how tests impact on decision-making and patient health.

• Screening

We have experience in designing and evaluating studies of screening tests and tools. We have strong links with the Warwick Screening Group, and have collaborated on many projects.

• Monitoring

Our team has expertise in studies using tests for the purpose of monitoring. We have investigated methodological issues for both the design and analysis of these studies.

• Prognosis and prediction rules

As well as diagnostic test evaluation, our team works on projects developing and validating models and prediction rules. We are close collaborators with the Centre for Prognosis Research at Keele University.

Cochrane COVID-19 Diagnostic Test Accuracy Reviews

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and resulting COVID-19 pandemic present important diagnostic evaluation challenges. As part of a multi–institute international collaboration, we are undertaking a series of Cochrane ‘living reviews’ of Diagnostic Test Accuracy to cover the roles of tests and characteristics in the diagnosis of COVID-19. Published reviews include signs and symptoms (e.g. fever or cough, oxygen saturation or lung auscultation findings), routine laboratory markers and thoracic imaging, as well reviews of SARS-CoV-2 specific biomarkers such as antibody tests and point-of-care rapid antigen or molecular tests. Three more reviews are ongoing, covering the effect of sampling methods on accuracy, laboratory-based tests that could be alternatives to RT-PCR, and ‘eNoses’.

Additional COVID-19 related work

In addition to our suite of reviews we have offered expert opinion and analysis on planned test use, the information provided and communication of results for new tests, and the  appropriate design of studies for newly developed tests. Our publications are listed below:

• Deeks JJ, Singanayagam A, Houston H, Sitch AJ, Hakki S, Dunning J et al. SARS-CoV-2 antigen lateral flow tests for detecting infectious people: linked data analysis BMJ 2022; 376 :e066871 doi:10.1136/bmj-2021-066871
• Raffle A, Taylor-Phillips S,  Sitch A. Mapping the outcomes of covid-19 testing reveals the best opportunities for system improvement. BMJ Opinion. 2021.
  
• Royal Statistical Society. Royal Statistical Society Diagnostic Tests Working Group Report. London, Royal Statistical Society. 2021.
• Doust JA, Bell KJL, Leeflang MMG, Dinnes J, Lord SJ, Mallett S, van de Wijgert J, Sandberg S, Adeli K, Deeks JJ, Bossuyt PM, Horvath AR. Guidance for the design and reporting of studies evaluating the clinical performance of tests for present or past SARS-CoV-2 infection. BMJ 2021;372:n568. doi: 10.1136/bmj.n568 [published Online First: 2021/03/31]
• Dinnes J. Covid-19 rapid antigen testing strategies require careful evaluation. EBioMedicine 2021; 70: 103491. doi: 10.1016/j.ebiom.2021.103491
• Deeks, J.J., Dinnes, J., Davenport, C., Takwoingi, Y., McInnes, M., Leeflang, M.M. and Cunningham, J. (2021). Letter to the Editor regarding Peto T; UK Covid-19 Lateral Flow Oversight Team: Covid-19: Rapid antigen detection for SARS-CoV-2 by lateral flow assay. EClinicalMedicine 2021; 38: 101037. Doi: 10.1016/j.eclinm.2021.101037
• Dinnes J, Davenport C, Do we have informed consent for asymptomatic testing in schools? 16 Mar 2021.
  
• Deeks JJ, Why the school testing regime needs to change. 2021.
• Deeks JJ, Gill M, Bird S, Richardson S, and Ashby D. Covid-19 INNOVA testing in schools: don’t just test, evaluate. Jan 12. 2021.
• Ferguson J, Dunn S, Best A, et al. Validation testing to determine the effectiveness of lateral flow testing for asymptomatic SARS-CoV-2 detection in low prevalence settings medRxiv 2020.12.01.20237784
  
• Deeks JJ, Raffle AE. Lateral flow tests cannot rule out SARS-CoV-2 infection. BMJ. 2020 Dec 11;371:m4787. doi: 10.1136/bmj.m4787. PMID: 33310701.
• Taylor-Phillips S, Berhane S, Sitch AJ et al. Information given by websites selling home self-sampling COVID-19 tests: An analysis of accuracy and completeness. BMJ Open 2020; 10:e042453. doi: 10.1136/bmjopen-2020-042453
• Raffle AE and Taylor–Phillips S. Test, Test, Test: Lessons learned from experience with mass screening programmes. A report written for Independent Sage, summarising implications for best practice when evaluating tests in public settings. Advice note for Independent Sage 5 June 2020.
• Deeks JJ, Brookes AJ, Pollock AM. Operation Moonshot proposals are scientifically unsound BMJ 2020; 370 :m3699.
• Watson J, Richter A, Deeks JJ. Testing for SARS-CoV-2 antibodies BMJ 2020; 370 :m3325. 

Key collaborators

• Cochrane Infectious Diseases Group 
• Cochrane Netherlands 
• Universities of Amsterdam, Utrecht, Leuven and Ottawa
• World Health Organization 
• FIND

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Honorary Researchers:

 

PhD students:

 

 

• Biomarker and Test Evaluation (BiTE) Program, University of Amsterdam (Prof Bossuyt & Dr Leeflang)
• Birmingham Clinical Trials Unit
• Cochrane
• Cochrane Infectious Diseases Group (CIDG)
• Cochrane Screening and Diagnostic Tests Methods Group
• Julius Center for Health Sciences and Primary Care, UMC Utrecht
• NIHR ARC West Midlands
• NIHR Birmingham Biomedical Research Centre 
• The Centre for Prognosis Research, Keele University (led by Prof Richard Riley)
• Warwick Screening
• WHO Essential Diagnostics List

Primary studies

• ATHENA - OpticAl Coherence TomograpHy Angiography for the dEtection of Neovascular Age-related Macular Degeneration: a Comprehensive Diagnostic Accuracy
• ATHENA-M - Observational Study Of Age, Test THreshold And Frequency On English NAtional Mammography Screening Outcomes
• BOSS-2 - Birmingham Objective Scar Scale project is a prospective study to examine the validity of a panel of objective burn scar measurement tools.
• The Chapter Study - Childbirth Acquired Perineal Trauma Study. A study to optimise the care of women following childbirth related perineal trauma (CRPT).
• COPE-West Midlands - The contribution of occupational exposures to risk of COVID-19 and approaches to control among healthcare workers
• eGFR-C - Accuracy of glomerular filtration rate (GFR) estimation using creatinine and cystatin C and albuminuria for monitoring disease progression in patients with stage 3 chronic kidney disease: prospective longitudinal study in a multi-ethnic population
• ELaTION - The efficacy and cost effectiveness of real time ultrasound Elastography in The Investigation Of thyroid Nodules and the diagnosis of thyroid cancer
• LACTATE - Using lactate testing to improve maternal sepsis identification: a multi-country test accuracy study: LACTate in mATernal sEpsis
• mTBI-Predict - Mild Traumatic Brain Injury Biomarker Study, a prospective cohort biomarker study of military and civilian participants with mTBI
• PredicTR2 - Validating the PredicTR treatment response classifier for oropharyngeal cancer
• PRIME - Prostate Imaging using MRI +/- contrast Enhancement
• PRiMUS - Primary Care Management of lower Urinary tract Symptoms in men: Development and validation of a diagnostic and decision–making aid
• ROCkeTS - Refining Ovarian Cancer Test Accuracy Scores is a diagnostic test accuracy study that aims to identify, refine and validate tests and clinical risk scores (risk prediction models) that estimate the probability of having ovarian cancer in post and premenopausal women with symptoms. ROCkeTS–Gen is a sub–study that aims to recruit post–menopausal women only.
• TrUSt NAFLD - Translating the potential of the urine steroid metabolome to stage NAFLD

Secondary studies

• COVID-19 Cochrane Test Accuracy Reviews - Published reviews include signs and symptoms  (e.g. fever or cough, oxygen saturation or lung auscultation findings), routine laboratory markers and thoracic imaging, as well reviews of SARS-CoV-2 specific biomarkers such as antibody tests and point-of-care rapid antigen or molecular tests.
• ROCkeTS - Refining Ovarian Cancer Test Accuracy Scores. A series of 3 test accuracy systematic reviews of the accuracy of symptom combinations, biomarkers and test combinations for detecting ovarian cancer in pre and post-menopausal women

Methodological research

• Evaluation of diagnostic imaging test performance including interobserver variability. A NIHR doctoral fellowship project which involves methodological research through systematic reviews, case and simulation studies. If interested, please get in touch with Laura Quinn
• Methods to Evaluate Screening in collaboration with Warwick Screening
• Opportunities and Challenges in Using Routine Data Sources to Evaluate Biomarkers
• TEST (Test Evaluation Using Structured Tools). An UK MRC funded project, launched in 2020. If you evaluate diagnostic tests (by study, review or policy discussion) and are interested in contributing to the design of a new tool to decide which studies to use to most efficiently evaluate a diagnostic, get in touch at  terg-testproject@contacts.bham.ac.uk

Primary studies

• APPEAL - Antenatal Preventative Pelvic Floor Exercises and Localisation) A review of the accuracy of tests to detect pelvic floor muscle dysfunction in symptomatic adults.
• BUS - Accuracy of Bladder Ultrasound Study
• Breathewell - Comparative test accuracy studies in Brazil and China
• ENDCaPC - Enhanced Neoplasia Detection and Cancer Prevention in Chronic Colitis - A Multicentre test accuracy study
• EURINE-ACT - An international prospective study that examines the diagnostic and prognostic value of urine steroidobolomics in patients with adrenocortical tumours.
• IDEA - Interferon gamma release assays for Diagnostic Evaluation of Active tuberculosis: test accuracy study and economic evaluation
• IDENTIFY - Investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer – a multicentre observational study
• MEDAL - Can magnetic resonance imaging scan replace or triage the use of laparoscopy in establishing a diagnosis amongst women presenting in secondary care with chronic pelvic pain?
• METRIC - MR Enterography and Small Bowel Ultrasound for the extent and activity of newly diagnosed and relapsed Crohn’s disease
• PET-PANC - multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer
• PRECISION - Prostate Evaluation for Clinically Important Disease: sampling Using Image–guidance or Not?
• PREDICT - An NIHR HTA study on Prognostic Value of Interferon Gamma Release Assays in predicting active tuberculosis among individuals with, or at risk of, latent tuberculosis infection
• RAPID - Real-time Adaptive Predictive Indicator of Deterioration 'Wireless technology breathes new life into medical practices' Birmingham Health Partners
• STREAMLINE - C - Streamlining Staging of Colorectal cancer with Whole Body MRI
• STREAMLINE- L - Streamlining Staging of Lung cancer with Whole Body MRI
• VANTDET - Validation of New Technologies for Diagnostic Evaluation of Tuberculosis

Secondary studies

• CATCH-ME - Characterising Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly
• Long-term impact of giving antibiotics before skin incision versus after cord clamping on children born by caesarean section
• Series of systematic reviews on the accuracy of diagnostic tests to diagnose and stage skin cancer in adults

Methodological research

• Evaluating the benefits for patients and the NHS of new and existing biological fluid biomarkers in liver and renal disease. 
• PRISMA-DTA - Diagnostic test accuracy extension to PRISMA checklist.
• QUADAS C

We organise and are affiliated with a number of research evens which promote the understanding and knowledge of test evaluation and medical statistics.

CPD courses

• Systematic reviews and meta-analyses of diagnostic test accuracy

A 3-day course in partnership with the University of Amsterdam which has been running annually since 2014.

• Evaluating medical tests: How do we tell if this biomarker or diagnostic test is any good?  

The course which launched in 2019 provides training and how to conduct primary studies that evaluate biomarkers and diagnostic tests.

Aimed at research teams who are developing diagnostic tests, this course covers the design, analysis and interpretations of primary studies.

If you wish to express interest in attending one of our courses in the future or have any queries about the courses, please email TERG@contacts.bham.ac.uk

Regular meetings and seminars

• TERG sessions

Every month, we hold a team meeting which services a dual purpose of providing methodological support to teams evaluating medical tests. Teams can reserve a one-hour slot to present their project and queries and provide round-table discussions on methodological solutions.

• Biomarker Club

In association with the NIHR Birmingham Biomedical Research Centre, we launched a Biomarker Club for University of Birmingham researchers who are actively involved in developing and/or evaluating diagnostic tests. These meetings aim to provide the opportunity to learn about test evaluation methods, share research challenges and network.

For further information about the TERG sessions or Biomarker Club, please contact TERG@contacts.bham.ac.uk

Conferences

• MEMTAB

In 2008, we launched the world’s first symposium focussed on methods for evaluating medical tests called `The Methods for Evaluating Medical prediction Models, Tests and Biomarkers’ (MEMTAB).

Online resources

Free materials for conducting reviews and meta–analyses of diagnostic test accuracy are available through Cochrane’s Screening and Diagnostic Test Methods group as training materials and the DTA handbook. 

• Freeman K, Dinnes J, Chuchu N, Takwoingi Y, Bayliss SE, Matin RN, Jain A, Walter FM, Williams HC, Deeks JJ. Algorithm-based smartphone ‘apps’ for assessment of the risk of skin cancer in adults: a systematic review of diagnostic accuracy studies. BMJ 2020; 368 https://doi.org/10.1136/bmj.m127
• Wolff RF, Moons KG, Riley RD, Whiting PF, Westwood M, Collins GS, Reitsma JB, Kleijnen J, Mallett S: PROBAST: A tool to assess the risk of bias and applicability of prediction model studies. Annals of Internal Medicine 2019, 170(1):51-58.
• Takwoingi Y, Whitworth H, Rees-Roberts M, Badhan A, Partlett C, Green N, Boakye A, Lambie H, Marongiu L, Jit M, White P, Deeks J, Kon O, Lalvani A on behalf of the IGRAs for Diagnostic Evaluation of Active TB (IDEA) Study Group. Interferon gamma release assays for Diagnostic Evaluation of Active tuberculosis (IDEA): test accuracy study and economic evaluation. Health Technol Assess 2019;23(23).
• Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA,… Deeks J, Takwoingi Y, Emberton M, Moore CM; PRECISION Study Group Collaborators. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med. 2018 May 10;378(19):1767-1777. doi: 10.1056/NEJMoa1801993
• Whiting P, Leeflang M, de Salis I, Mustafa RA, Santesso N, Gopalakrishna G, Cooney G, Jesper E, Thomas J, Davenport C. How to write a plain language summary for a diagnostic test accuracy review.  J Clin Epidemiol 103 (2018) 112-119.
• Takwoingi Y, Leeflang MM, Deeks JJ. Empirical evidence of the importance of comparative studies of diagnostic test accuracy. Ann Intern Med. 2013;158(7):544-54.
• Ferrante di Ruffano L, Hyde CJ, McCaffery KJ, Bossuyt PM, Deeks JJ. Assessing the value of diagnostic tests: a framework for designing and evaluating trials. 2012. BMJ. http://dx.doi.org/10.1136/bmj.e686 

Please send an email to TERG@contacts.bham.ac.uk for all enquiries, unless indicated in the relevant section above.