Epidemiology and Reporting Characteristics of Systematic Reviews of Biomedical Research: A Cross-Sectional Study.
Epidemiology and Reporting Characteristics of Systematic Reviews of Biomedical Research: A Cross-Sectional Study.
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DOI：
10.1371/journal.pmed.1002028
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发表时间：
2016-05
期刊：
影响因子：
15.8
通讯作者：
Moher D
中科院分区：
文献类型：
--
作者：
Page MJ;Shamseer L;Altman DG;Tetzlaff J;Sampson M;Tricco AC;Catalá-López F;Li L;Reid EK;Sarkis-Onofre R;Moher D
系统性综述（SR）可以帮助决策者解释大量已发表的生物医学文献。然而，如果用于进行SR的方法存在缺陷，并且SR的报告不完整，则SR的用途可能有限。据我们所知，自2004年以来，没有对不同专业SR报告的患病率、重点和完整性进行横断面研究。因此，我们的研究的目的是调查的流行病学和报告的特点，最近的横截面的SR。我们检索了MEDLINE，以识别2014年2月期间索引的潜在合格SR。使用预先规定的合格性标准筛选引文。由一名审查员提取300份SR随机样本的流行病学和报告特征，其中10%的样本提取两份。我们比较了科克伦与非科克伦综述的特征，以及2014年SR样本与2004年SR样本的特征。我们确定了682个SR，这表明每年有超过8，000个SR被编入MEDLINE索引，相当于过去十年增加了3倍。大多数SR涉及治疗问题，由中国、英国或美国的作者进行;它们包括15项研究（中位数），涉及2，072例受试者。在63%的SR中进行了荟萃分析，主要使用标准配对方法。在70%的SR中进行了偏倚/质量评估的研究风险，但很少纳入分析（16%）。少数SR（7%）检索了未发表数据的来源，并且在不到一半的SR中考虑了发表偏倚的风险。报告质量参差不齐;至少三分之一的SR未报告使用SR方案、与发表状态相关的合格性标准、检索覆盖年数、至少一个数据库的完整布尔检索逻辑、数据提取方法、研究偏倚风险评估方法、主要结局、包含研究局限性的抽象结论，占样本15%的科克伦员工代表比其他类型的员工代表报告更完整。自2004年以来，报告总体上有所改善，但在许多方面仍不理想。越来越多的工作人员代表被公布，许多工作人员代表的执行和报告都很差。需要制定战略来帮助减少研究中这种可避免的浪费。在一项横断面手稿分析中，大卫·莫赫（David Moher）及其同事对2014年发表的跨医学学科系统性综述的患病率、行为质量和报告完整性进行了评分。医疗保健方面的决定，例如推荐哪种治疗或订购哪种测试，应该基于所有现有研究的证据，而不是最大或最新研究的结果。系统性综述明确使用方法来识别、选择、批判性评估和综合给定问题的所有现有研究的结果，被认为是决策者的最高水平证据。我们想知道有多少生物医学研究的系统性综述正在发表，它们正在解决什么问题，以及这些方法的报道情况如何，因为自2004年以来没有收集过这类信息。我们查找了一个月内（2014年2月）添加到生物医学文献主要书目数据库中的所有系统性综述，并记录了这些综述的特征。我们发现了682篇系统性综述，比过去十年增加了3倍，涉及广泛的主题。在许多情况下，所用方法的重要方面没有报告（例如，至少三分之一的综述没有报告他们如何搜索研究或如何评估纳入研究的质量），很少寻求未发表的数据，至少三分之一的综述使用了已制定系统性综述指南的领先组织所不鼓励的统计方法。（例如，科克伦和医学研究所）。我们的结论是，系统评价已经变得越来越受欢迎，并且与十年前类似，行为和报告的质量差异很大;因此，读者不应该不加批判地接受系统评价的结果。我们建议采取一些策略来提高系统评价的价值，例如开发软件以促进更好的报告，对期刊编辑进行如何使用PRISMA（http：//prisma-statement.org/）等报告指南的认证培训，以及对生物医学研究人员进行研究设计和分析的正式培训。
Systematic reviews (SRs) can help decision makers interpret the deluge of published biomedical literature. However, a SR may be of limited use if the methods used to conduct the SR are flawed, and reporting of the SR is incomplete. To our knowledge, since 2004 there has been no cross-sectional study of the prevalence, focus, and completeness of reporting of SRs across different specialties. Therefore, the aim of our study was to investigate the epidemiological and reporting characteristics of a more recent cross-section of SRs. We searched MEDLINE to identify potentially eligible SRs indexed during the month of February 2014. Citations were screened using prespecified eligibility criteria. Epidemiological and reporting characteristics of a random sample of 300 SRs were extracted by one reviewer, with a 10% sample extracted in duplicate. We compared characteristics of Cochrane versus non-Cochrane reviews, and the 2014 sample of SRs versus a 2004 sample of SRs. We identified 682 SRs, suggesting that more than 8,000 SRs are being indexed in MEDLINE annually, corresponding to a 3-fold increase over the last decade. The majority of SRs addressed a therapeutic question and were conducted by authors based in China, the UK, or the US; they included a median of 15 studies involving 2,072 participants. Meta-analysis was performed in 63% of SRs, mostly using standard pairwise methods. Study risk of bias/quality assessment was performed in 70% of SRs but was rarely incorporated into the analysis (16%). Few SRs (7%) searched sources of unpublished data, and the risk of publication bias was considered in less than half of SRs. Reporting quality was highly variable; at least a third of SRs did not report use of a SR protocol, eligibility criteria relating to publication status, years of coverage of the search, a full Boolean search logic for at least one database, methods for data extraction, methods for study risk of bias assessment, a primary outcome, an abstract conclusion that incorporated study limitations, or the funding source of the SR. Cochrane SRs, which accounted for 15% of the sample, had more complete reporting than all other types of SRs. Reporting has generally improved since 2004, but remains suboptimal for many characteristics. An increasing number of SRs are being published, and many are poorly conducted and reported. Strategies are needed to help reduce this avoidable waste in research. In a cross-sectional manuscript analysis, David Moher and colleagues score the prevalence, quality of conduct and completeness of reporting among systematic reviews published across medical disciplines in 2014. Decisions in health care, such as which treatment to recommend or which test to order, should be based on evidence from all available research studies, rather than the results of the largest or most recent study. Systematic reviews, which explicitly use methods to identify, select, critically appraise, and synthesize the results of all existing studies of a given question, are considered the highest level of evidence for decision makers. We wanted to know how many systematic reviews of biomedical research are being published, what questions they are addressing, and how well the methods are reported, since information of this sort has not been collected since 2004. We looked for all systematic reviews added to the main bibliographic database for biomedical literature during one month (February 2014), and recorded the characteristics of these reviews. We found 682 systematic reviews—a 3-fold increase over the last decade—that addressed a wide range of topics. In many cases, important aspects of the methods used were not reported (for example, at least a third of the reviews did not report how they searched for studies or how they assessed the quality of the included studies), unpublished data was rarely sought, and at least a third of the reviews used statistical methods discouraged by leading organizations that have developed guidance for systematic reviews (for example, Cochrane and the Institute of Medicine). We conclude that systematic reviews have become increasingly popular and that, similar to a decade ago, the quality of conduct and reporting varies widely; therefore, readers should not accept the findings of systematic reviews uncritically. We recommend a number of strategies to improve the value of systematic reviews, such as the development of software to facilitate better reporting, certified training for journal editors in how to implement the use of reporting guidelines such as PRISMA (http://prisma-statement.org/), and formal training of biomedical researchers in research design and analysis.