Discrepancies among megatrials
Discrepancies among megatrials
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DOI：
10.1016/s0895-4356(00)00250-x
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发表时间：
2000-12-01
影响因子：
7.2
通讯作者：
Hori, S
中科院分区：
文献类型：
--
作者：
Furukawa, TA;Streiner, DL;Hori, S
最近通过将荟萃分析的结果与同一主题的大型试验的结果进行比较来检验荟萃分析的有效性。我们通过识别大型试验（定义为涉及超过 1000 名受试者的试验）来研究这一黄金标准的可靠性，这些试验在最近一期的 Cochrane 图书馆和 LeLorier 等人的文章中得到了证实。 (N Engl J Med 1997,337:536-42)。在前一组中，确定了 289 对大型试验，这些试验研究相同的患者干预结果组合。其中，210 名（73%，95% CI：67-77%）报告的比值比或加权平均差异彼此之间没有统计学上的显着差异。关于结果的统计结论的一致性为 0.40 的二次加权 kappa（95% CI：0.29-0.51）。 LeLorier 等人的文章。产生了 133 项比较，其中 97 项（73%，95% CI：64-79%）报告了相互兼容的比值比。统计结论的一致性为 0.33（95% CI：0.18-0.47）。大型试验之间的一致性大约与荟萃分析和大型试验之间报告的一致。这些发现表明，将大型试验作为黄金标准可能存在问题，并且对于任何研究，无论是荟萃分析还是大型试验，都无法替代清晰而认真的思考。 (C) 2000 Elsevier Science Inc. 保留所有权利。
The validity of meta-analyses has recently been examined by comparing their results with those of megatrials on the same topic. We investigated the reliability of this gold standard by identifying megatrials, defined as ones involving more than 1000 subjects, in the recent issue of the Cochrane Library and in the article by LeLorier er al. (N Engl J Med 1997,337:536-42). In the former set, 289 pairs of megatrials were identified which studied the same patient-intervention-outcome combinations. Of these, 210 (73%, 95% CI: 67-77%) reported odds ratios or weighted mean differences that were not statistically significantly different from each other. The agreement of statistical conclusions regarding outcomes was a quadratic weighted kappa of 0.40 (95% CI: 0.29-0.51). The article by LeLorier et nl. yielded 133 comparisons, of which 97 (73%, 95% CI: 64-79%) reported mutually compatible odds ratios. The agreement of statistical conclusions was a kappa of 0.33 (95% CI: 0.18-0.47). Agreement among megatrials was approximately as large as that reported between meta-analyses and megatrials. These findings suggest that taking megatrials as the gold standard can be problematic and that there is no substitute for clear and hard thinking for any study, be it a meta-analysis or a megatrial. (C) 2000 Elsevier Science Inc. All rights reserved.