ADOS-2在真实世界临床转诊人群中各模块的诊断准确性：一项更新的系统综述和HSROC荟萃分析
Module-specific diagnostic accuracy of ADOS-2 in real-world clinical referral populations: an updated systematic review and HSROC meta-analysis.
摘要(中文译文)
自闭症诊断观察量表第二版（ADOS-2）广泛应用于自闭症谱系障碍（ASD）的诊断评估；然而，其在真实世界临床转诊人群中的诊断性能仍存在异质性，尤其是在不同模块和临床情境之间。本系统综述与荟萃分析采用分层荟萃分析建模评估ADOS-2各模块的诊断准确性，并在更新的临床研究证据中探讨异质性来源。系统检索PubMed/MEDLINE、Scopus和Web of Science数据库，检索时间为2021年1月至2026年2月，并补充筛选参考文献列表。纳入标准为：在真实世界临床转诊人群中评估ADOS-2诊断准确性的研究，以基于DSM或ICD的临床最佳估计诊断作为参考标准，并报告可提取的2×2数据。采用双变量随机效应方法的分层汇总受试者工作特征（HSROC）模型合并诊断准确性。进行各模块分析（幼儿模块、模块1-2、模块3、模块4）及荟萃回归以探讨异质性。共10项研究纳入定性综合，其中6项提供可提取的2×2数据用于定量合并。总体合并灵敏度为0.88（95% CI：0.83-0.92），合并特异度为0.74（95% CI：0.68-0.80），HSROC曲线下面积（AUC）为0.86。幼儿模块显示出最高的诊断性能（灵敏度0.92；特异度0.88；AUC 0.94），而模块3和模块4的特异度下降。荟萃回归确定模块级别、精神科转诊环境和成人样本是特异度降低的显著影响因素。未检测到显著的发表偏倚。ADOS-2在真实世界临床转诊人群中表现出较高的总体灵敏度，但各模块间特异度存在差异。特异度降低更常见于较高ADOS-2模块，这些模块通常用于语言流利的青少年和成人，且其精神科复杂性更高。
Abstract
The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), is widely used in the diagnostic evaluation of autism spectrum disorder (ASD); however, its diagnostic performance in real-world clinical referral populations remains heterogeneous, particularly across modules and clinical contexts. This systematic review and meta-analysis evaluated the module-specific diagnostic accuracy of ADOS-2 using hierarchical meta-analytic modeling and examined sources of heterogeneity in updated evidence clinical studies. A systematic search of PubMed/MEDLINE, Scopus, and Web of Science was conducted from January 2021 to February 2026, with additional screening of reference lists. Studies were included if they evaluated ADOS-2 diagnostic accuracy in real-world clinical referral populations, used DSM- or ICD-based clinical best-estimate diagnosis as the reference standard, and reported extractable 2×2 data. Diagnostic accuracy was pooled using a hierarchical summary receiver operating characteristic (HSROC) model with a bivariate random-effects approach. Module-specific analyses (Toddler Module, Modules 1-2, Module 3, Module 4) and meta-regression were performed to examine heterogeneity. Ten studies were included in the qualitative synthesis, and six provided extractable 2×2 data for quantitative pooling. Overall pooled sensitivity was 0.88 (95% CI: 0.83-0.92) and pooled specificity was 0.74 (95% CI: 0.68-0.80), with an HSROC AUC of 0.86. The Toddler Module showed the highest diagnostic performance (sensitivity 0.92; specificity 0.88; AUC 0.94), whereas specificity decreased in Modules 3 and 4. Meta-regression identified module level, psychiatric referral setting, and adult samples as significant contributors to reduced specificity. No significant publication bias was detected. ADOS-2 demonstrates high overall sensitivity but variable specificity across modules in real-world clinical referral populations. Reduced specificity was more commonly observed in higher ADOS-2 modules, which are typically administered to verbally fluent adolescents and adults with greater psychiatric complexity.
如何引用
AMA
Senay Kılıncel, Furkan Bulut, Pelin Goksel, Mirac Baris Usta, Oguzhan Kilincel. Module-specific diagnostic accuracy of ADOS-2 in real-world clinical referral populations: an updated systematic review and HSROC meta-analysis.. Frontiers in psychiatry. 2026; doi:10.3389/fpsyt.2026.1840734.
APA
Senay Kılıncel, Furkan Bulut, Pelin Goksel, Mirac Baris Usta, Oguzhan Kilincel (2026). Module-specific diagnostic accuracy of ADOS-2 in real-world clinical referral populations: an updated systematic review and HSROC meta-analysis.. Frontiers in psychiatry. https://doi.org/10.3389/fpsyt.2026.1840734
GB/T 7714
Senay Kılıncel, Furkan Bulut, Pelin Goksel, Mirac Baris Usta, Oguzhan Kilincel. Module-specific diagnostic accuracy of ADOS-2 in real-world clinical referral populations: an updated systematic review and HSROC meta-analysis.[J]. Frontiers in psychiatry, 2026 doi:10.3389/fpsyt.2026.1840734.
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