Statistical heterogeneity in systematic reviews of clinical trials: a critical appraisal of guidelines and practice.
Statistical heterogeneity in systematic reviews of clinical trials: a critical appraisal of guidelines and practice.
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DOI：
10.1258/1355819021927674
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发表时间：
2002-01-01
影响因子：
2.4
通讯作者：
Altman, Douglas
中科院分区：
文献类型：
--
作者：
Higgins, Julian;Thompson, Simon;Altman, Douglas
目的：研究结果之间的异质性可能是任何系统评价或临床试验荟萃分析中的一个问题。识别它的存在，调查它的原因，并在分析中正确地解释它，所有这些都涉及研究人员的困难决定。我们的目标是：整理关于临床试验系统评价中异质性处理的建议;调查科克伦评价中异质性处理的现行做法;并将现行做法与建议进行比较。我们回顾了那些进行系统评价的指南，并研究了异质性在实践中是如何在系统评价的样本及其协议中解决的，结果：对评价者的建议总体上是一致和合理的。然而，对科克伦研究方案和综述样本的检查表明，考虑到许多系统性综述中确定的研究数量较少，难以预先指定亚组分析或荟萃回归的重要效应修饰符，以及关于固定效应与随机效应荟萃分析的未解决的争论，该建议很难遵循。有协议和审查之间的分歧，往往是关于重要的潜在效应修饰剂的选择，或由于审查确定太少的研究进行计划analysis.CONCLUSION：指南，解决实际问题，需要减少风险的虚假调查结果的异质性。这可能涉及不鼓励统计调查，如亚组分析和荟萃回归，而不是简单地采取谨慎的方法来解释它们，除非有大量的研究。对研究进行回顾性审查时，潜在效应修饰因子的先验规范概念定义不清，使用异质性统计检验来决定分析策略的适当性值得怀疑。
OBJECTIVE: Heterogeneity between study results can be a problem in any systematic review or meta-analysis of clinical trials. Identifying its presence, investigating its cause and correctly accounting for it in analyses all involve difficult decisions for the researcher. Our objectives were: to collate recommendations on the subject of dealing with heterogeneity in systematic reviews of clinical trials; to investigate current practice in addressing heterogeneity in Cochrane reviews; and to compare current practice with recommendations.METHODS: We review guidelines for those undertaking systematic reviews and examine how heterogeneity is addressed in practice in a sample of systematic reviews, and their protocols, from the Cochrane Database of Systematic Reviews.RESULTS: Advice to reviewers is on the whole consistent and sensible. However, examination of a sample of Cochrane protocols and reviews demonstrates that the advice is difficult to follow given the small numbers of studies identified in many systematic reviews, the difficulty of pre-specifying important effect modifiers for subgroup analysis or meta-regression and the unresolved debate concerning fixed versus random effects meta-analyses. There was disagreement between protocols and reviews, often either regarding choice of important potential effect modifiers or due to the review identifying too few studies to perform planned analyses.CONCLUSION: Guidelines that address practical issues are required to reduce the risk of spurious findings from investigations of heterogeneity. This may involve discouraging statistical investigations such as subgroup analyses and meta-regression, rather than simply adopting a cautious approach to their interpretation, unless a large number of studies is available. The notion of a priori specification of potential effect modifiers for a retrospective review of studies is ill-defined, and the appropriateness of using a statistical test for heterogeneity to decide between analysis strategies is suspect.