期刊
JOURNAL OF CLINICAL EPIDEMIOLOGY
卷 64, 期 6, 页码 608-618出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jclinepi.2010.08.002
关键词
Meta-analysis; Systematic review; Cochrane Collaboration; Heterogeneity; Publication bias; Random-effects
资金
- United Nations Development Programme/United Nations Population Fund/World Health Organization (WHO)/World Bank
- WHO, Geneva, Switzerland
Objectives: To assess statistical methods within systematic reviews of the Cochrane Pregnancy and Childbirth Group (CPCG). Study Design and Setting: We extracted details about statistical methods within 75 reviews containing at least 10 studies. Results: The median number of forest plots per review was 52 (min = 5; max = 409). Seven of the 75 reviews assessed publication bias or explained why not. Forty-four of the 75 reviews performed random-effects meta-analyses; just 1 of these justified the approach clinically and none interpreted its pooled result correctly. Of 31 reviews not using random-effects, 26 assumed a fixed-effect given potentially moderate or large heterogeneity (I-2 > 25%). In their Methods section, 25 (33%) of the 75 reviews said I-2 was used to decide between fixed-effect and random-effects; however, in 12 of these (48%) reviews, this was not carried out in their Results section. Of 72 reviews with moderate or large heterogeneity, 47 (65%) did not explore the causes of heterogeneity or justify why not. Conclusion: Within CPCG reviews, publication bias is rarely addressed; heterogeneity is often not appropriately considered, and random-effects analyses are incorrectly interpreted. How these shortcomings impact existing review conclusions needs further investigation, but regardless of this, we recomment the Cochrane Collaboration increase hands-on statistical support. (C) 2011 Elsevier Inc. All rights reserved.
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