How quickly do systematic reviews go out of date? A survival analysis
How quickly do systematic reviews go out of date? A survival analysis
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DOI：
10.7326/0003-4819-147-4-200708210-00179
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发表时间：
2007-08-21
影响因子：
39.2
通讯作者：
Moher, David
中科院分区：
文献类型：
--
作者：
Shojania, Kaveh G.;Sampson, Margaret;Moher, David
背景资料：系统评价通常被认为是指导临床决策和医疗保健政策的最佳证据来源，但我们对它们需要更新的程度知之甚少。目的：估计证据变化的平均时间，这些证据足够重要，需要更新系统评价。设计：100例定量系统评价的生存分析样本：1995年至2005年发表的系统评价，并在ACP期刊俱乐部中索引。符合条件的综述评价了特定的药物或药物、器械或手术，仅包括随机或准随机对照试验。测量：用于更新的定量信号为统计学显著性变化或效应幅度的相对变化至少50%，涉及原始系统综述的主要结局之一或任何死亡结局。定性信号包括有效性特征的实质性差异、有关危害的新信息以及有关先前报告的会影响临床决策的发现的警告。结果：100项系统性综述的队列中，平均包括13项研究，每次综述有2663名参与者。57%的综述（95%CI，47%至67%）出现了更新的定性或定量信号。无更新信号的中位生存期为5.5年（CI，4.6 - 7.6年）。然而，23%的评论在2年内出现信号，15%的评论在1年内出现信号。7%的患者在发布时已经出现了信号。只有4%的综述在报告的检索期结束后1年内有信号; 11%在检索后2年内有信号。较短的生存期与心血管疾病相关（风险比，2.70 [Cl，1.36 - 5.34]）和原始综述中的异质性（风险比，2.15 [Cl，1.12至4.11]）。局限性：在没有内容专家参与的情况下做出了是否需要更新的判断。在一组与临床实践直接相关的高质量系统性综述中，更新信号频繁发生，且发生时间相对较短。
Background: Systematic reviews are often advocated as the best source of evidence to guide clinical decisions and health care policy, yet we know little about the extent to which they require updating.Objective: To estimate the average time to changes in evidence that are sufficiently important to warrant updating systematic reviews.Design: Survival analysis of 100 quantitative systematic reviewsSample: Systematic reviews published from 1995 to 2005 and indexed in ACP Journal Club. Eligible reviews evaluated a specific drug or class of drug, device, or procedure and included only randomized or quasi-randomized, controlled trials.Measurements: Quantitative signals for updating were changes in statistical significance or relative changes in effect magnitude of at least 50% involving 1 of the primary outcomes of the original systematic review or any mortality outcome. Qualitative signals included substantial differences in characterizations of effectiveness, new information about harm, and caveats about the previously reported findings that would affect clinical decision making.Results: The cohort of 100 systematic reviews included a median of 13 studies and 2663 participants per review. A qualitative or quantitative signal for updating occurred for 57% of reviews (95% Cl, 47% to 67%). Median duration of survival free of a signal for updating was 5.5 years (Cl, 4.6 to 7.6 years). However, a signal occurred within 2 years for 23% of reviews and within 1 year for 15%. In 7%, a signal had already occurred at the time of publication. Only 4% of reviews had a signal within 1 year of the end of the reported search period; 11% had a signal within 2 years of the search. Shorter survival was associated with cardiovascular topics (hazard ratio, 2.70 [Cl, 1.36 to 5.34]) and heterogeneity in the original review (hazard ratio, 2.15 [Cl, 1.12 to 4.11]).Limitation: Judgments of the need for updating were made without involving content experts.Conclusion: In a cohort of high-quality systematic reviews directly relevant to clinical practice, signals for updating occurred frequently and within a relatively short time.