The medical review article revisited: has the science improved?

The validity of a review depends on its methodologic quality.

To determine the methodologic quality of recently published review articles.

Critical appraisal.

All reviews of clinical topics published in six general medical journals in 1996.

Explicit criteria that have been published and validated were used.

Of 158 review articles, only 2 satisfied all 10 methodologic criteria (median number of criteria satisfied, 1). Less than a quarter of the articles described how evidence was identified, evaluated, or integrated; 34% addressed a focused clinical question; and 39% identified gaps in existing knowledge. Of the 111 reviews that made treatment recommendations, 48% provided an estimate of the magnitude of potential benefits (and 34%, the potential adverse effects) of the treatment options, 45% cited randomized clinical trials to support their recommendations, and only 6% made any reference to costs.

The methodologic quality of clinical review articles is highly variable, and many of these articles do not specify systematic methods.