在对元分析和大型试验之间的比较方面存在问题
J P Ioannidis1, J C Cappelleri, J Lau
1National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20852, USA. ji24m@nih.gov
JAMA
|April 18, 1998
概括
分析和大型试验之间的差异取决于研究选择和终点定义. 仔细评估这些临床证据工具对于医疗实践指导至关重要.
科学领域:
- 临床流行病学 临床流行病学
- 基于证据的医学基于证据的医学.
背景情况:
- 通过使用各种协议,调查元分析和大型试验之间的一致性.
- 不一致的结论使人们对这些临床证据工具的可靠性提出了疑问.
研究的目的:
- 评估协议,比较元分析和大型试验.
- 了解这两种研究方法的一致性存在分歧的原因.
主要方法:
- 系统地比较协议设计.
- 分析研究选择,协议定义和分析方法.
- 检查报告的大型试验和元分析之间的差异.
主要成果:
- 当大型试验来自有影响力的期刊或包括次要终点时,差异增加.
- 根据定义,一致性差异很大 (kappa 0.22-0.72);治疗效果相关性范围从 -0.12 到 0.76.
- 大型试验与元分析不同意10-23%的时间,当大小和不确定性被考虑时;归因于疾病风险,协议,质量和偏见.
结论:
- 在比较大型试验和元分析时,研究和终点选择会影响结论.
- 对这两种研究方法的批判性评估提高了它们在指导医疗实践中的有用性.
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