EULAR releases checklist to ensure transparency in all studies using ultrasound
EULAR has released a list of 23 recommendations — including 21 “mandatory” items — such as blinding, the development of scoring systems and defining target pathologies, for all rheumatic and musculoskeletal disease studies using ultrasound.
According to the authors, this checklist, published in the Annals of the Rheumatic Diseases, would ensure “transparent and comprehensive reporting” in all such ultrasound studies, as well as improve interpretability.
“This work comes from the observation that there is a lot of interest about the use of ultrasound for diagnosis, monitoring and follow-up in patients with rheumatic and musculoskeletal disorders,” Maria-Antonietta D'Agostino, MD, MSc, PhD, of the Catholic University of the Sacred Heart and Gemelli University Hospital, in Rome, told Healio Rheumatology. “Several papers have been published in the past 20 years, most of them in highly cited journals.”
“However, in these papers, information such as definitions for ultrasound-detected pathologies, scoring systems or technical issues are missing,” she added. “This information, along with critical design characteristics, are often suboptimally reported in current ultrasound studies and may affect the validity and generalizability of the published results.”
To develop a series of recommendations for reporting the results of ultrasound studies in rheumatic and musculoskeletal diseases, D’Agostino and colleagues led a multidisciplinary task force of 23 members from 11 European countries and the United States. The EULAR task force included 11 experts in rheumatic and musculoskeletal disease ultrasound, seven in methodology, one in both ultrasound and methodology, two in biostatistics, one patient research partner and one health professional working in rheumatology.
Following a literature review and Delphi surveys collecting expert opinion, the group drafted a preliminary checklist. This list was later refined with the help of a panel of 79 external experts, including musculoskeletal imaging experts, methodologists, journal editors, who evaluated items for comprehensibility, feasibility and comprehensiveness. The task force finalized the checklist over the course of two face-to-face meetings and two Delphi voting rounds. Agreement on each item was assessed using an 11-point Likert scale.
The task force ultimately approved a set of 23 recommendations, including 21 “mandatory” and two “optional” items. The checklist is organized into 13 categories, covering study objectives, design, participants, blinding, ultrasound features, scanning, ultrasound scoring, readers, equipment, images, contextual factors, statistical analysis and disclosures.
The two optional recommendations, to be reported only when applicable, are possible confounding factors — such as ambient conditions — or the experience of the sonographers. Mandatory items include the procedures for blinding sonographers and participants, information on the scoring system used, and definitions of target pathologies.
“We produced a checklist of 23 items that should be always reported in every paper focused on or using ultrasound in rheumatic and musculoskeletal diseases,” D’Agostino said. “We believe that, as for other reporting checklists — such as CONSORT or STARD — the use of this checklist will improve the interpretability, reproducibility and generalizability of study results, and ultimately the quality of patient care.”
“Moreover, this is the first reporting checklist focused on how to report characteristics of imaging measurement tools,” she added. “We hope that the large use of this checklist will help in spreading the use of ultrasound as an objective, and nonoperator-dependent, tool.”