Abstract
Purpose
Randomized controlled trials (RCTs) are suitable for meta-analysis and systematic reviews provided they are of high quality and are easy to retrieve. We determined these attributes of RCTs in obstetrical anaesthesia in a sample of available journals that are indexed in MEDLINE.
Source
Randomized controlled trials published between January 1985 and December 1994 in seven anaesthetic and three obstetric journals were identified by a MEDLINE search, and by handsearch of the same journals. Each RCT was assigned a quality score by a blinded rater using a reliable and validated scale. The quality of each RCT was described and compared over time and by journal. The comparative yield of MEDLINE and handsearch was evaluated.
Principal findings
Three hundred and forty RCTs were retrieved by MEDLINE and handsearch. Two hundred and twenty seven (65%) were identified by the MEDLINE search and 333 by the handsearch (98%). The median quality score was 3/5. There was no difference in score over time.Anesthesiology had the highest median score.Anaesthesia had the lowest (P < 0.05).
Conclusions
Care must be taken when reviewing obstetrical anaesthesia research. Strategies in addition to a MEDLINE search must be used to identify RCTs since more than one third were missed using MEDLINE alone. Poor quality RCTs are more likely to be biased in favour of a new treatment. Therefore, to increase the validity of reviews sensitivity analyses based on quality should be done.
Résumé
Objectif
Les épreuves aléatoires avec contrôles (EAC) se prêtent bien à la méta-analyse et aux survols systématiques en autant qu’ils sont de bonne qualité et faciles à récupérer. Les auteurs ont déterminé les caractéristiques des EAC en anesthésie obstétricale sur un échantillon de revues indexées dans MEDLINE.
Sources
Les épreuves aléatoires avec contrôles publiées entre janvier 1985 et décembre 1994 dans sept revues d’anesthésie et trois revues d’obstétrique étaient identifiés au cours d’une recherche dans MEDLINE et par une recherche visuelle des mêmes revues. Un évaluateur neutre assignait un score de qualité à l’aide d’une échelle fiable et validée. La qualité de chaque EAC était vérifiée et comparée relativement au moment de sa parution et de son origine. La compilation obtenue grâce à MEDLINE était comparée au recueil visuel.
Constations principales
II faut être prudent quand on analyse la recherche en anesthésie obstétricale. Comme plus du tiers des EAC a été omis dans MEDLINE, on doit aussi rechercher ailleurs. Les EAC de qualité médiocre sont susceptibles d’afficher un biais en faveur d’un nouveau traitement. Dès lors, pour augmenter la validité des analyses des articles de révision, il faut effectuer des analyses de sensibilité basées sur la qualité.
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References
Moher D, Olkin I. Meta-analysis of randomized controlled trials. A concern for standards. JAMA 1995; 274: 1962–3.
Petitti DB. Meta-Analysis, Decision Analysis, and Cost-Effectiveness Analysis. Methods for Quantitive Synthesis in Medicine. New York: Oxford University Press, 1994.
Dickersin K, Scherer R, Lefebvre C. Identifying relevant studies for systematic reviews. BMJ 1994; 309: 1286–91.
Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995; 273: 408–12.
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clinical Trials. 1996; 17: 1–12.
Streiner DL, Norman GR. Health Measurement Scales. A Practical Guide to their Development and Use, 2nd ed. Toronto: Oxford University Press, 1995.
Dickersin K, Hewitt P, Mutch L, Chalmers I, Chalmers TC. Perusing the literature: comparison of MEDLINE searching with a perinatal trials database. Controlled Clinical Trials 1985; 6: 306–17.
Bero L, Rennte D. The Cochrane collaboration: preparing, maintaining, and disseminating systematic reviews of the effects of health care. JAMA 1995; 274: 1935–8.
The Standards of Reporting Trials Group. A proposal for structured reporting of randomized controlled trials. JAMA 1994; 272: 1926–31.
Pitkin RM, Burmeister LF. Routine statistical screening revisited (Editorial). Obstet Gynecol 1995; 86: 124–5.
Begg C, Cho M, Eastwood S, et al. Improving the quality of reporting of randomized controlled trials: The CONSORT statement. JAMA 1996; 276: 637–9.
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J.S. Bender was supported by a summer studentship from the Medical Research Council of Canada. The work was presented in part at the International Anesthesia Research Society meeting in Washington DC March 9, 1996.
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Bender, J.S., Halpern, S.H., Thangaroopan, M. et al. Quality and retrieval of obstetrical anaesthesia randomized controlled trials. Can J Anesth 44, 14–18 (1997). https://doi.org/10.1007/BF03014317
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DOI: https://doi.org/10.1007/BF03014317