Meta-analyses in paediatric surgery are often fragile: implications and consequences.

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.