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Meta-analyses in paediatric surgery are often fragile: implications and consequences
Arne Schröder1,2, Oliver J Muensterer3,4, Christina Oetzmann von Sochaczewski5,6
1Klinik für Kinder- und Jugendmedizin, Elisabeth-Krankenhaus, Essen, Germany.
Insights
Paediatric surgical meta-analyses often lack robustness, with statistical significance frequently depending on minimal patient data. The fragility index, a measure of this robustness, suggests many conclusions are unreliable and should be interpreted cautiously.
Area of Science:
- Paediatric surgery
- Evidence-based medicine
- Biostatistics
Background:
- Meta-analyses represent the highest level of evidence, guiding clinical decisions.
- The fragility index quantifies the robustness of statistical significance in research findings.
- Evaluating the fragility of paediatric surgical meta-analyses is crucial for reliable clinical guidance.
Purpose of the Study:
- To assess the robustness of findings in paediatric surgical meta-analyses using the fragility index.
- To determine the impact of small changes in data on the statistical significance of paediatric surgical meta-analyses.
Main Methods:
- Systematic search of MEDLINE for paediatric surgical meta-analyses published in the last decade.
- Inclusion criteria: meta-analyses on paediatric surgical conditions with statistically significant conclusions.
- Calculation of the fragility index for included meta-analyses.
Main Results:
- 39 meta-analyses, comprising 79 statistically significant results, were included.
- The median fragility index was 5, indicating a low threshold for losing statistical significance.
- The median fragility relative to the patient population was 0.77%, highlighting the fragility of conclusions.
Conclusions:
- Paediatric surgical meta-analyses frequently demonstrate fragility, with significance often dependent on less than 1% of the population.
- The fragility index, while informative, is a transformation of the P-value and may not offer novel insights.
- Caution is advised when interpreting the statistical significance of paediatric surgical meta-analyses due to their inherent fragility.
Purpose:
Meta-analyses occupy the highest level of evidence and thereby guide clinical decision-making. Recently, randomised-controlled trials were evaluated for the robustness of their findings by calculating the fragility index. The fragility index is the number of events that needs to be added to one treatment arm until the statistical significance collapses. We, therefore, aimed to evaluate the robustness of paediatric surgical meta-analyses.
Methods:
We searched MEDLINE for paediatric surgical meta-analyses in the last decade. All meta-analyses on a paediatric surgical condition were eligible for analysis if they based their conclusion on a statistically significant meta-analysis.
Results:
We screened 303 records and conducted a full-text evaluation of 60 manuscripts. Of them, 39 were included in our analysis that conducted 79 individual meta-analyses with significant results. Median fragility index was 5 (Q25-Q75% 2-11). Median fragility in relation to included patients was 0.77% (Q25-Q75% 0.29-1.87%).
Conclusion:
Paediatric surgical meta-analyses are often fragile. In almost 60% of results, the statistical significance depends on less than 1% of the included population. However, as the fragility index is just a transformation of the P value, it basically conveys the same information in a different format. It therefore should be avoided.
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