INCORPORATING VARIATIONS IN THE QUALITY OF INDIVIDUAL RANDOMIZED TRIALS INTO METAANALYSIS
INCORPORATING VARIATIONS IN THE QUALITY OF INDIVIDUAL RANDOMIZED TRIALS INTO METAANALYSIS
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DOI：
10.1016/0895-4356(92)90085-2
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发表时间：
1992-03-01
影响因子：
7.2
通讯作者：
LABBE, KA
中科院分区：
文献类型：
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作者：
DETSKY, AS;NAYLOR, CD;LABBE, KA
荟萃分析是一种综合多种来源证据的方法。它已经越来越多地应用于结合治疗策略的随机试验结果。不幸的是，荟萃分析中纳入的试验的质量常常存在差异，这限制了将结果合并为综述的价值。这种质量上的差异会导致治疗效果估计的偏差和准确性降低。有许多量化试验质量的方法，包括详细的查尔默斯系统和简单的量表。这些质量分数与有效性的真实估计之间的关系的性质目前尚不清楚。我们讨论了将质量纳入元分析的四种方法：阈值评分作为纳入/排除标准，使用质量评分作为统计池中的权重，对质量评分的效应大小的视觉图以及基于质量评分的试验结果的顺序组合。最后一种方法允许检验混合估计的质量与偏差和精度之间的关系。我们的结论是，虽然有可能将单个试验质量变化的影响纳入概述，但这个问题需要更多的研究。
Meta-analysis is a method of synthesizing evidence from multiple sources. It has been increasingly applied to combine results from randomized trials of therapeutic strategies. Unfortunately there is often variation in the quality of the trials that are included in meta-analyses, limiting the value of combining the results in an overview. This variation in quality can lead to both bias and reduction in precision of the estimate of the therapy's effectiveness.There are a number of methods for quantifying the quality of trials including the detailed Chalmers system and simple scales. The nature of the relationship between these quality scores and the true estimate of effectiveness is unknown at this time.We discuss four methods of incorporating quality into meta-analysis: threshold score as inclusion/exclusion criterion, use of quality score as a weight in statistical pooling, visual plot of effect size against quality score and sequential combination of trial results based on quality score. The last method permits an examination of the relation between quality and both bias and precision on the pooled estimates.We conclude that while it is possible to incorporate the effect of variation of quality of individual trials into overviews, this issue requires more study.