Domain	Explanation
Risk of bias	Based on results of risk of bias assessments. Certainty in the evidence base was downgraded if most of the evidence was from studies not judged to be at low risk of bias.
Imprecision	Certainty in the evidence base was downgraded if the estimate of the effect size from a meta‐analysis was not precise. We downgraded by 2 levels if (i) the upper 95% confidence limit for either sensitivity or specificity was more than 2 times the lower limit or (ii) the total sample size was 50 or less; and by 1 level if an upper limit was more than 1.4 times the lower limit.
Inconsistency	Certainty in the evidence base was downgraded if there was unexplained heterogeneity or variability in results across studies.
Indirectness	Based on QUADAS‐2 assessments of applicability. Certainty in the evidence base was downgraded if most of the evidence was from studies judged to have low applicability to the review question.
Publication bias	Certainty in the evidence base was downgraded if we uncovered evidence of publication bias.