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Several diagnostic criteria have been developed to effectively diagnose systemic lupus erythematosus (SLE). Three criteria are most common, namely the American College of Rheumatology (ACR)-1997, the Systemic Lupus International Collaborating Clinics (SLICC)-2012, and the European League Against Rheumatism (EULAR/ACR)-2019. Whether they also apply to juvenile SLE is unclear. To examine the diagnostic accuracy of ACR-1997, SLICC-2012, and EULAR/ACR-2019 for juvenile SLE. A comprehensive search of PubMed, Cochrane, and Embase was conducted up to 26 March 2022. We included all study designs in which patients had any index tests for ACR-1997, SLICC-2012, or EULAR/ACR-2019; both full-text papers and conference abstracts published in English were used. Exclusion criteria were as follows: (1) case reports; (2) adult subjects; or (3) did not report sufficient information to acquire true positive, false positive, true negative, and false negative values of diagnostic criteria. Two authors independently screened studies, extracted relevant data, and assessed the risk of bias. First, a meta-analysis of the diagnostic accuracy of EULAR/ACR-2019 and a hierarchical summary receiver operating characteristic (HSROC) model was performed to estimate sensitivity and specificity with 95% confidence intervals (CIs). We then carried out a network meta-analysis to compare the performances of these three diagnostic criteria. In total, 17 relevant studies that included 2339 juvenile SLE patients were eligible to analyze pooled accuracy. In the meta-analysis, 10 studies (1613 cases) reported the diagnostic performance of EULAR/ACR-2019, showing a pooled sensitivity of 0.92 (95% CI, 0.89–0.95), pooled specificity of 0.89 (0.77–0.95), and area under HSROC of 0.96 (0.94–0.97). In the network meta-analysis, the SLICC-2012 (0.94, 0.92–0.96) had the highest sensitivity, followed by EULAR/ACR-2019 (0.93, 0.90–0.95), and ACR-1997 (0.78, 0.72–0.82); the ACR-1997 (0.96, 0.92–0.98) demonstrated the highest specificity. EULAR/ACR-2019 (0.92, 0.87–0.96) and SLICC-2012 (0.92, 0.86–0.96) had the similar specificity. We found that the applicability of the new EULAR/ACR-2019 criteria in juvenile SLE is not yet the best diagnostic tool. PROSPERO CRD42022321514. • This study represents the first network meta-analysis of diagnostic test accuracy to compare the performance of ACR-1997, SLICC-2012, and EULAR/ACR-2019 criteria for juvenile systemic lupus erythematosus. • For EULAR/ACR-2019, we determined the performance of the new EULAR/ACR-2019 criteria to have an area under the curve value of 0.96. • Among all of the included studies, we found EULAR/ACR-2019 not to be the best tool for diagnosing juvenile systemic lupus erythematosus; SLICC-2012 has better sensitivity, and ACR-1997 has better specificity. [ABSTRACT FROM AUTHOR]

Abstract: Studies of accuracy are often more complex to understand than clinical trials, since there can be more than one outcome and scope (screening, diagnosis, and prognosis) and because results have to be reported in more than one way, than in clinical trials (relative risk or odds ratio). Sensitivity and specificity are common terms for practitioners, but to remember that sensitivity is the “ratio between true positive rate and true positive rate plus false negative rate” may sometime cause some frustration. Moreover, likelihood ratio, predictive values, diagnostic odds ratio, and pre- and post-test probability complicate the framework. To summarize these indexes from multiple studies can be also a little more difficult. However, understanding diagnostic test accuracy from different study results and how to interpret systematic reviews and meta‐analysis can help every practitioner improve critical appraisal of evidence about the best use of diagnostic tests. Avoiding complicated mathematical formulas, this paper attempts to explain the meaning of the most important diagnostic indexes and how to read a Forest plot and a summary Receiver Operative Characteristic curve. [Copyright &y& Elsevier]