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Misclassification of Case-Control Studies in Neurosurgery and Proposed Solutions
Ignatius Ngene Esene1, Lawrence Mbuagbaw2, Gilbert Dechambenoit3
1Department of Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA; Gamma Knife Center, Nasser Institute, Cairo, Egypt.
World Neurosurgery
|February 7, 2018
Summary
Nearly 41% of neurosurgery studies mislabel their design as case-control studies (CCS). This misclassification, often confusing cohort studies (CS) for CCS, distorts evidence and requires better training and adherence to reporting guidelines.
Area of Science:
- Neurosurgical research methodology
- Observational study designs
Background:
- Case-control studies (CCS) and cohort studies (CS) are prevalent in neurosurgery.
- Misuse of the term "case-control study" is frequent in the neurosurgical literature.
- Many reported CCS do not adhere to fundamental methodological criteria.
Purpose of the Study:
- To quantify the extent of mislabeling of case-control study designs in neurosurgery.
- To identify factors contributing to the incorrect classification of study designs.
- To improve the reporting standards for observational studies in neurosurgery.
Main Methods:
- A systematic search of 31 top-ranking neurosurgical journals was conducted.
- Articles titled or abstracted as CCS were evaluated against STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.
- Duplicate assessment ensured reliability of study design classification (agreement κ = 99.82%).
Main Results:
- Out of 224 included articles, 59.38% were correctly labeled as CCS, while 40.62% were misclassified.
- Cohort studies (CS) were the most common mislabeled design (33.93%), with retrospective CS being frequent (25.45%).
- Mislabeling leads to impaired evidence indexing, incorrect evidence level downgrading, and distorted effect size measurements (e.g., odds ratios instead of relative risk).
Conclusions:
- A significant proportion of neurosurgical studies labeled as CCS are not accurately classified.
- Implementation of reporting guidelines, such as STROBE, is crucial for correct study design labeling.
- Enhanced training in research methodology for neurosurgical researchers, alongside increased vigilance from editors and reviewers, is recommended.
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