STAN technology, surrogate outcomes and possible sources of bias

Acta Obstetricia Et Gynecologica Scandinavica
Ellen BlixPål Øian

Abstract

We appreciate the comments from Olofsson (1) and Kessler et al (2). We investigated several outcomes in our review, and two (risk of metabolic acidosis and operative vaginal delivery) showed statistically significant differences in favor of STAN. (3). Two other high quality meta-analyses were published almost simultaneously (4, 5), and neither reported significant differences in rates of metabolic acidosis. Saccone et al. (4) and Neilson (5) used risk ratio (RR) and random effect models, whereas we used peto OR and fixed effect model for outcomes with an incidence <1%. Both approaches have pros and cons and we hesitate defining either one as superior. Olofsson argues that we did the most correct meta-analysis (3). Positive feedback is always welcome, but it is tempting to ask whether this judgment is related to the fact that our meta-analysis shows positive results for metabolic acidosis whereas the others do not. We once again emphasize the need to see all results in context, particularly when the only interesting effect manifests itself in a surrogate outcome with uncertain clinical validity. This article is protected by copyright. All rights reserved.

References

Jun 1, 2008·Expert Review of Pharmacoeconomics & Outcomes Research·Ariel Alonso, Geert Molenberghs
Feb 18, 2015·BMJ : British Medical Journal·Bjørn Morten Hofmann
Aug 13, 2015·The New England Journal of Medicine·Michael A BelfortUNKNOWN Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network
Feb 4, 2016·Acta Obstetricia Et Gynecologica Scandinavica·Per Olofsson
Feb 18, 2016·Acta Obstetricia Et Gynecologica Scandinavica·Jörg KesslerTore Henriksen

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Citations

Jun 17, 2016·Acta Obstetricia Et Gynecologica Scandinavica·Ellen BlixPål Øian
Apr 14, 2019·American Journal of Obstetrics and Gynecology·Isis Amer-WåhlinUNKNOWN Study Group of Intrapartum Fetal Monitoring (European Association of Perinatal Medicine)

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