How do systematic reviews incorporate risk of bias assessments into the synthesis of evidence? A methodological study
How do systematic reviews incorporate risk of bias assessments into the synthesis of evidence? A methodological study
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DOI：
10.1136/jech-2014-204711
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发表时间：
2015-02-01
影响因子：
6.3
通讯作者：
Petticrew, Mark
中科院分区：
文献类型：
--
作者：
Katikireddi, Srinivasa Vittal;Egan, Matt;Petticrew, Mark
背景系统评价（SR）预期将严格评价纳入的研究，并在综合中优先考虑偏倚风险最低（RoB）的研究。本研究探讨是否以及如何关键评价通知合成和解释的证据在SRs.Methods所有SR发表在2012年3月至5月的14个高排名的医学期刊和样本从科克伦图书馆进行了系统的评估，以确定是否和如何：关键评价进行;结果在研究的59个工作人员代表中，除6个（90%）外，所有工作人员代表都对所纳入的研究进行了严格的评估，大多数使用或调整了现有的工具。几乎一半的工作人员代表报告了批评性评价，其方式使读者无法确定综述中包含的哪些研究最可靠。三分之一（20）的SR未将RoB评估纳入综合，当审查集中于随机对照试验时，更有可能考虑RoB评估。将关键评价纳入综合过程的常用方法是敏感性分析、叙述性讨论和排除高RoB研究。近一半的审查，调查多个结果，并进行了研究层面的RoB摘要没有考虑潜在的RoB不同outcome.Conclusions的SR，发表在主要期刊的结论，往往是不知情的关键评估过程中，即使进行。这对于公共卫生主题的工作人员代表来说可能特别成问题，因为这些主题往往采用不同的研究设计。
Background Systematic reviews (SRs) are expected to critically appraise included studies and privilege those at lowest risk of bias (RoB) in the synthesis. This study examines if and how critical appraisals inform the synthesis and interpretation of evidence in SRs.Methods All SRs published in March-May 2012 in 14 high-ranked medical journals and a sample from the Cochrane library were systematically assessed by two reviewers to determine if and how: critical appraisal was conducted; RoB was summarised at study, domain and review levels; and RoB appraisals informed the synthesis process.Results Of the 59 SRs studied, all except six (90%) conducted a critical appraisal of the included studies, with most using or adapting existing tools. Almost half of the SRs reported critical appraisal in a manner that did not allow readers to determine which studies included in a review were most robust. RoB assessments were not incorporated into synthesis in one-third (20) of the SRs, with their consideration more likely when reviews focused on randomised controlled trials. Common methods for incorporating critical appraisals into the synthesis process were sensitivity analysis, narrative discussion and exclusion of studies at high RoB. Nearly half of the reviews which investigated multiple outcomes and carried out study-level RoB summaries did not consider the potential for RoB to vary across outcomes.Conclusions The conclusions of the SRs, published in major journals, are frequently uninformed by the critical appraisal process, even when conducted. This may be particularly problematic for SRs of public health topics that often draw on diverse study designs.