Empirical assessment of effect of publication bias on meta-analyses

Objective To assess the effect of publication bias on the results and conclusions of systematic reviews and meta-analyses. Design Analysis of published meta-analyses by trim and fill method, Studies 48 reviews in Cochrane Database of Systematic Reviews that considered a binary endpoint and contained 10 or more individual studies. Main outcome measures Number of reviews with missing studies and effect on conclusions of meta-analyses. Results The trim and fill fixed effects analysis method estimated that 26 (54%) of reviews had missing studies and in 10 the number missing was significant. The corresponding figures with a random effects model were 23 (48%) and eight. In four cases, statistical inferences regarding the effect of the intervention were changed after the overall estimate for publication bias was adjusted for. Conclusions Publication or related biases were common within the sample of meta-analyses assessed. In most cases these biases did not affect the conclusions, Nevertheless, researchers should check routinely whether conclusions of systematic reviews are robust to possible non-random selection mechanisms.