PMID: 8947790Nov 1, 1996Paper

The use and misuse of meta-analysis

Journal of Accident & Emergency Medicine
F E LeckyP Brennan

Abstract

To demonstrate how the results of a meta-analysis can confuse rather than clarify therapeutic dilemmas if clinical heterogeneity among trials is ignored. Then to further discuss the qualities emergency physicians should expect from published meta-analyses if they are to affect clinical practice. The data and results were examined from 23 randomised controlled trials of selective decontamination of the digestive tract (SDD), which have been combined in a previous meta-analysis. These were reviewed to take account of clinical heterogeneity, particularly with regard to severity of patient illness. Severity of patient illness predicts degree of reduction in mortality with SDD in a regression analysis: log odds ratio (OR) of death with SDD = -0.0074 - (0.0035 x control group mortality rate), P = 0.017. This is also true when trials are stratified into more and less severely ill patients: pooled OR (a) for CMR > 41% = 0.69 (0.54 to 0.89), with (b) CMR < 3% = 1.02 (0.86 to 1.21). This difference was not suggested by the original meta-analysis result. Failure to take account of clinical heterogeneity between trials can mean a meta-analysis result ignores important differences in the effect of a treatment on different groups of patients...Continue Reading

References

Jul 1, 1994·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·C M Olson
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May 22, 1993·BMJ : British Medical Journal·G D SmithT A Sheldon

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Citations

Mar 18, 2009·Dental Traumatology : Official Publication of International Association for Dental Traumatology·Susan Elisabeth Hinckfuss, Louise Brearley Messer
Jun 5, 2021·Health·Caitlin Vitosky Clarke, Brynn C Adamson

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