腹腔外科手术后延长预防的脆弱性指数:一个方法调查
Tyler McKechnie1, Ruxandra-Maria Bogdan2, Kelly Brennan2
1Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
American journal of surgery
|October 25, 2024
概括
大型腹腔皮层手术后延长静脉血栓塞栓症预防 (VTEp) 的证据脆弱性较低. 随机对照试验 (RCT) 中的统计学意义上的发现并不强大,表明需要谨慎.
科学领域:
- 医学研究方法论医学研究方法论.
- 临床试验分析临床试验分析
- 基于证据的医学是基于证据的医学.
背景情况:
- 脆弱性指数 (FI) 量化了随机对照试验 (RCT) 中统计学上显著的p值的稳定性.
- FI是必须将非事件变为事件的最小数量,以使研究结果变得无意义.
- 这项研究评估了证据的脆弱性,支持在重大腹腔皮层手术后扩展静脉血栓塞栓症预防 (VTEp).
研究的目的:
- 评估随机对照试验 (RCT) 中报告的统计学显著结果的稳定性,这些结果涉及在接受重大腹膜外科手术的患者中延长静脉血栓塞栓症预防 (VTEp).
主要方法:
- 从开始到2023年11月,在MEDLINE,Embase和CENTRAL进行了系统的文献搜索.
- 包括并行,双臂,优越性设计RCT,将扩展VTEp与具有统计学意义的二分结果的对照进行比较.
- 脆弱性指数是使用Walsh等人计算的. "的方法论. 这是一个很好的方法.
主要成果:
- 从611个引用中确定了6个具有12个统计学意义的试验结果的RCT.
- 折指数的中位数为1.5 (范围:1-4),平均每RCT有419名患者.
- 在83.3%的结局中,失去了随访的患者数量超过了脆弱性指数.
结论:
- 在RCT中,经过重大腹腔皮层手术后延长VTEp的统计学意义上的发现缺乏稳定性.
- 在这种外科背景下支持扩展VTEp的证据是脆弱的.
- 由于证据的稳定性较低,应谨慎对这些重大发现进行临床解释.
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