Diagnostic Accuracy Study Report Template (STARD 2015)
Diagnostic accuracy study report: STARD 2015 items, intended use, test methods, flow diagram, 2x2 table, sensitivity, specificity, likelihood ratios
Mode d'emploi: Use it when reporting a study that compares an index test with a reference standard. Fill the participant flow and the 2x2 table first, then compute every estimate from them. The main pitfall is excluding invalid or unverified results silently, which inflates accuracy.
Aperçu
Diagnostic Accuracy Study Report: [Index test] for [target condition]
Report template for a study that estimates how well a test (the index test) identifies a target condition against a reference standard. The sections follow the topics and order of STARD 2015 (30 essential items, BMJ 2015;351:h5527), with the participant flow diagram and the 2x2 cross-tabulation. STARD item numbers appear in brackets, for example [12a]. Topics are written in original words; use the template with the official STARD 2015 checklist and flow diagram from the EQUATOR Network. For tests that use artificial intelligence, also use STARD-AI (2025). This is a reporting format, not clinical, statistical or regulatory advice. Replace every
[bracketed]value and every row marked Example.
Document control
| Field | Value |
|---|---|
| Document ID | [DAS-001] |
| Study acronym | [ACRONYM] |
| Index test(s) | [Name, manufacturer, version or software release] |
| Reference standard | [Name and version] |
| Target condition | [Condition and definition] |
| Registration | [Registry name and number] |
| Protocol version reported against | [Protocol v2.0, YYYY-MM-DD] |
| Reporting guideline | STARD 2015 [plus STARD-AI or STARD for Abstracts where used] |
| Version | [0.1] |
| Status | [Draft / In review / Approved] |
| Owner | [@principal-investigator] |
| Approvers | [@statistician], [@laboratory-lead] |
| Last updated | YYYY-MM-DD |
| Classification | [Confidential until publication] |
Approvals
| Role | Name | Decision | Date |
|---|---|---|---|
| Principal investigator | [@name] | [Approved] | YYYY-MM-DD |
| Statistician | [@name] | [Approved] | YYYY-MM-DD |
| Laboratory or reference standard lead | [@name] | [Approved] | YYYY-MM-DD |
Revision history
| Version | Date | Author | Change summary |
|---|---|---|---|
| 0.1 | YYYY-MM-DD | [@name] | First draft after data lock |
| 0.2 | YYYY-MM-DD | [@name] | Example: Added sensitivity analysis for invalid index test results |
| 1.0 | YYYY-MM-DD | [@name] | Approved for submission |
Contents
1. Title and abstract
The title and abstract let readers recognise the study design and its main result.
1.1 Title [1]
Diagnostic accuracy of [index test] for [target condition] in [population and setting]: a [prospective, cross-sectional] study
Example: "Sensitivity and specificity of a point-of-care rapid antigen test for group A streptococcal pharyngitis in children: a prospective diagnostic accuracy study."
1.2 Structured abstract [2]
| Heading | Content |
|---|---|
| Objective | [Accuracy of which test, for which condition, in whom] |
| Design and setting | [Prospective, consecutive series, number and type of sites] |
| Participants | [Eligibility in brief] |
| Index test and reference standard | [Both, with positivity thresholds] |
| Results | Example: Of 640 children enrolled, 620 were included in the analysis; 170 (27.4%) had a positive culture. Sensitivity 87.1% (95% CI 81.2 to 91.3), specificity 93.1% (90.4 to 95.1). |
| Conclusions | [Intended use and limits, in one sentence] |
| Registration | [Registry and number] |
2. Introduction
The introduction sets out why the test matters and what the study tries to estimate.
2.1 Scientific and clinical background [3]
[Describe the target condition, the current pathway and the intended use and clinical role of the index test. Say what decision a positive or negative result should change.]
Example: Sore throat is common in children and most cases are viral. Culture takes 24 to 48 hours. A rapid test at the first visit could act as a replacement for culture in deciding on antibiotics, so a high sensitivity is needed to avoid missed infections.
| Role of the index test | Meaning | Accuracy usually emphasised |
|---|---|---|
| Replacement | Replaces an existing test | Similar or better than the existing test overall |
| Triage | Used before the existing test; only positives (or negatives) go on | High sensitivity (rule-out) or high specificity (rule-in) |
| Add-on | Used after the existing test | Gain in accuracy where the existing test is uncertain |
2.2 Objectives and hypotheses [4]
| ID | Objective | Hypothesis or target |
|---|---|---|
| OBJ-01 (Example) | Estimate the sensitivity and specificity of RAT-01 against throat culture in children aged 3 to 14 with sore throat | Lower 95% confidence limit of sensitivity at least 80% |
| OBJ-02 (Example) | Estimate positive and negative predictive values in this setting | Descriptive |
| OBJ-03 | [Variability by age group or symptom score] | [Prespecified or exploratory] |
3. Methods
The methods describe the design, participants and tests as they were used.
3.1 Study design [5]
[State whether data collection was planned before the index test and reference standard were done (prospective) or after (retrospective).]
3.2 Participants [6, 7, 8, 9]
| Item | Detail |
|---|---|
| Eligibility criteria [6] | Example: Children aged 3 to 14 presenting with sore throat of 7 days or less; excluded if antibiotics in the previous 14 days |
| Basis for identification [7] | Example: Presenting symptoms at triage |
| Setting, locations, dates [8] | Example: 6 urgent care clinics of the Westmere Paediatric Network, YYYY-MM-DD to YYYY-MM-DD |
| Sampling [9] | Example: Consecutive eligible children during clinic opening hours |
3.3 Test methods [10a, 10b, 11, 12a, 12b, 13a, 13b]
| Item | Index test | Reference standard |
|---|---|---|
| Description [10a, 10b] | Example: RAT-01 lateral flow assay, lot numbers recorded, performed by triage nurses after a 30-minute training | Throat culture on blood agar, read at 24 and 48 hours by laboratory staff |
| Rationale for the reference standard [11] | Not applicable | [Why it is the best available method; known limitations] |
| Positivity definition and threshold [12a, 12b] | Example: Any visible test line within 10 minutes, as in the instructions for use; prespecified | Any growth of group A streptococcus; prespecified |
| Information available to readers [13a, 13b] | Example: Readers saw symptoms but not culture results | Laboratory staff were not told the rapid test result |
4. Analysis
This section describes the statistical methods.
4.1 Estimating accuracy [14]
Accuracy is derived from the 2x2 table of index test result against reference standard result:
| Reference positive | Reference negative | |
|---|---|---|
| Index positive | TP (true positive) | FP (false positive) |
| Index negative | FN (false negative) | TN (true negative) |
[Name the method for confidence intervals, for example Wilson score intervals for proportions and the log method for likelihood ratios, and the software and version.] Predictive values depend on prevalence; report them only for the setting studied, or recalculate them for other prevalences with the likelihood ratios.
4.2 Indeterminate and missing results [15, 16]
| Situation | Handling |
|---|---|
| Invalid or indeterminate index test [15] | Example: Reported separately; excluded from the main analysis; sensitivity analysis counting them as wrong (worst case) and as right (best case) |
| Inconclusive reference standard [15] | [Repeat test / exclude / adjudication panel] |
| Missing index test or reference standard [16] | Example: Reported in the flow diagram; no imputation in the main analysis |
4.3 Variability analyses [17]
| ID | Analysis | Prespecified? |
|---|---|---|
| VAR-01 (Example) | Sensitivity by age group (3 to 5, 6 to 14) | Yes |
| VAR-02 | [By site or by reader] | [Yes / No, exploratory] |
4.4 Sample size [18]
The number of participants with the target condition needed for a given precision of sensitivity is:
Example: expected sensitivity , half-width and give , rounded up to 137 children with a positive culture. With an expected prevalence of 25%, children; allowing 10% for missing or invalid results, , rounded up to 609. Recruitment continued to the end of the planned season and enrolled 640.
5. Results
This section reports who took part and how accurate the test was.
5.1 Participant flow [19]
The diagram follows participants from eligibility to the final analysis.
Example: reasons for exclusion before enrolment: did not meet the criteria 118, declined 41, other 13 (total 172). Children in the main analysis: .
5.2 Baseline characteristics [20, 21a, 21b]
| Characteristic | Culture positive (n = [170]) | Culture negative (n = [450]) |
|---|---|---|
| Age, years, median (IQR) | Example: 7 (5 to 10) | 6 (4 to 9) |
| Female, n (%) | [84 (49.4)] | [226 (50.2)] |
| Clinical score at presentation, median | [Value] | [Value] |
| Severity in those with the condition [21a] | [Distribution, for example by clinical score] | Not applicable |
| Alternative diagnoses [21b] | Not applicable | [Viral pharyngitis, other] |
5.3 Time interval and interventions [22]
[Time between index test and reference standard, and any treatment started in between.] Example: both swabs were taken at the same visit (interval 0 days); no antibiotic was given before swabbing.
5.4 Cross-tabulation [23]
| Culture positive | Culture negative | Total | |
|---|---|---|---|
| RAT-01 positive (Example) | 148 (TP) | 31 (FP) | 179 |
| RAT-01 negative (Example) | 22 (FN) | 419 (TN) | 441 |
| Total | 170 | 450 | 620 |
5.5 Estimates of accuracy [24]
| ID | Measure | Calculation | Estimate (95% CI) |
|---|---|---|---|
| EST-01 (Example) | Sensitivity | 148 / 170 | 87.1% (81.2 to 91.3) |
| EST-02 (Example) | Specificity | 419 / 450 | 93.1% (90.4 to 95.1) |
| EST-03 (Example) | Positive predictive value | 148 / 179 | 82.7% (76.5 to 87.5) |
| EST-04 (Example) | Negative predictive value | 419 / 441 | 95.0% (92.6 to 96.7) |
| EST-05 (Example) | Positive likelihood ratio | 0.871 / 0.069 | 12.64 (8.95 to 17.84) |
| EST-06 (Example) | Negative likelihood ratio | 0.129 / 0.931 | 0.14 (0.09 to 0.21) |
| EST-07 (Example) | Prevalence in the sample | 170 / 620 | 27.4% (24.1 to 31.1) |
Confidence intervals: Wilson score for proportions, log method for likelihood ratios. The ratios in the calculation column are rounded for display; the estimates use unrounded values.
| ID | Sensitivity analysis | Sensitivity | Specificity |
|---|---|---|---|
| SEN-01 (Example) | 9 invalid results counted as wrong (worst case) | 148 / 173 = 85.5% | 419 / 456 = 91.9% |
| SEN-02 (Example) | 9 invalid results counted as right (best case) | 151 / 173 = 87.3% | 425 / 456 = 93.2% |
| VAR-01 | [Results by age group from section 4.3] | [Value] | [Value] |
5.6 Adverse events [25]
[Any adverse events from performing the index test or the reference standard.] Example: no adverse events beyond brief gagging during swabbing were recorded.
6. Discussion
The discussion interprets the estimates for the intended use of the test.
6.1 Limitations [26]
- [Sources of bias, for example imperfect reference standard or partial verification]
- [Statistical uncertainty, for example a wide interval for sensitivity in a subgroup]
- [Generalisability: setting, prevalence, operators and test version]
6.2 Implications for practice [27]
[State what the results mean for the intended use and clinical role.] Example: with a negative likelihood ratio of 0.14, a negative result lowers the probability of a positive culture from 27.4% to about 5.0% in this setting. Whether that is low enough to withhold culture is a clinical and guideline decision, not something this study settles.
7. Other information
| Item | Detail |
|---|---|
| Registration [28] | [Registry name and number] |
| Protocol access [29] | [Where the full protocol can be accessed] |
| Funding and role of funders [30] | [Funder; whether the manufacturer supplied tests, and its role in design, analysis and reporting] |
| Data and code | [Repository, access conditions] |
8. STARD cross-reference, glossary and references
This section maps the STARD 2015 items to this report and lists terms and sources.
8.1 STARD 2015 cross-reference
| Item | Topic (paraphrased) | Section |
|---|---|---|
| 1, 2 | Title, abstract | 1.1, 1.2 |
| 3, 4 | Background and intended use, objectives | 2.1, 2.2 |
| 5 | Prospective or retrospective design | 3.1 |
| 6 to 9 | Participants: eligibility, identification, setting, sampling | 3.2 |
| 10a, 10b, 11 | Index test, reference standard, rationale | 3.3 |
| 12a, 12b | Positivity definitions and thresholds | 3.3 |
| 13a, 13b | Information available to test readers | 3.3 |
| 14, 15, 16 | Estimation methods, indeterminate and missing results | 4.1, 4.2 |
| 17, 18 | Variability analyses, sample size | 4.3, 4.4 |
| 19 | Participant flow diagram | 5.1 |
| 20, 21a, 21b | Baseline characteristics, severity, alternative diagnoses | 5.2 |
| 22 | Time interval and interventions between tests | 5.3 |
| 23 | Cross-tabulation | 5.4 |
| 24 | Accuracy estimates with precision | 5.5 |
| 25 | Adverse events from testing | 5.6 |
| 26, 27 | Limitations, implications | 6.1, 6.2 |
| 28, 29, 30 | Registration, protocol, funding | 7 |
8.2 Glossary
| Term | Meaning |
|---|---|
| Index test | The test whose accuracy is evaluated |
| Reference standard | The best available method for establishing whether the target condition is present |
| Likelihood ratio | How much a result changes the odds of the target condition |
| Partial verification | Only some participants receive the reference standard, often chosen by index test result |
| Spectrum | The mix of severity and alternative diagnoses in the participants |
| QUADAS-3 | Tool for assessing risk of bias and applicability of diagnostic accuracy studies in systematic reviews |
8.3 References and related templates
| Reference | Version or date | Use |
|---|---|---|
| STARD 2015, Bossuyt PM et al., BMJ 2015;351:h5527, https://doi.org/10.1136/bmj.h5527 | 2015 | Reporting items |
| STARD 2015 explanation and elaboration, Cohen JF et al., BMJ Open 2016;6:e012799, https://doi.org/10.1136/bmjopen-2016-012799 | 2016 | Detailed guidance |
| STARD checklist and flow diagram, https://www.equator-network.org/reporting-guidelines/stard/ | Checked 2026-10-30 | Submission files |
| STARD-AI, Sounderajah V et al., Nat Med 2025;31:3283-3289, https://doi.org/10.1038/s41591-025-03953-8 | 2025 | Tests that use artificial intelligence |
| STARD for Abstracts, Cohen JF et al., BMJ 2017;358:j3751 | 2017 | Abstract |
| QUADAS-3, Whiting P et al., Ann Intern Med 2026;179(4):548-555, https://doi.org/10.7326/ANNALS-25-02104 | 2026 | How reviewers will appraise the study |
| academic/stats-contingency-tables, academic/stats-confidence-intervals | This collection | 2x2 tables and intervals |
| academic/stats-power-sample-size | This collection | Sample size reasoning |
| science/observational-study, science/prediction-model-report | This collection | Related designs |
| science/systematic-review-report | This collection | Reviews that pool accuracy studies |
Standard and licence note
Structure aligned with STARD 2015: Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, et al., STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies, BMJ 2015;351:h5527 (https://doi.org/10.1136/bmj.h5527), listed as the current guideline by the EQUATOR Network on 2026-10-30. This template follows the order of its 30 items, paraphrased in original text, and reproduces no checklist wording; use the official checklist and flow diagram for submission and check the EQUATOR page for updates and extensions. This is a reporting format, not clinical, statistical or regulatory advice. Template licence: MIT.
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