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用于医学决策的证据综合及质量评分的合理使用。

Evidence synthesis for medical decision making and the appropriate use of quality scores.

作者信息

Doi Suhail A R

机构信息

Associate Professor of Clinical Epidemiology, School of Population Health, University of Queensland, Brisbane, Australia

出版信息

Clin Med Res. 2014 Sep;12(1-2):40-6. doi: 10.3121/cmr.2013.1188. Epub 2014 Jan 10.

Abstract

Meta-analyses today continue to be run using conventional random-effects models that ignore tangible information from studies such as the quality of the studies involved, despite the expectation that results of better quality studies reflect more valid results. Previous research has suggested that quality scores derived from such quality appraisals are unlikely to be useful in meta-analysis, because they would produce biased estimates of effects that are unlikely to be offset by a variance reduction within the studied models. However, previous discussions took place in the context of such scores viewed in terms of their ability to maximize their association with both the magnitude and direction of bias. In this review, another look is taken at this concept, this time asserting that probabilistic bias quantification is not possible or even required of quality scores when used in meta-analysis for redistribution of weights. The use of such a model is contrasted with the conventional random effects model of meta-analysis to demonstrate why the latter is inadequate in the face of a properly specified quality score weighting method.

摘要

如今,荟萃分析仍在使用传统的随机效应模型,这些模型忽略了来自研究的切实信息,比如所涉研究的质量,尽管人们期望质量更高的研究结果能反映更有效的结果。先前的研究表明,从这种质量评估得出的质量分数在荟萃分析中不太可能有用,因为它们会产生有偏差的效应估计值,而这种偏差不太可能在所研究的模型中通过方差减少得到抵消。然而,先前的讨论是在将此类分数视为能够最大程度地与偏差的大小和方向相关联的背景下进行的。在本综述中,我们再次审视这一概念,这次断言在荟萃分析中用于权重重新分配时,质量分数不可能也甚至不需要进行概率偏差量化。将这种模型的使用与荟萃分析的传统随机效应模型进行对比,以说明为何在面对恰当指定的质量分数加权方法时,后者是不充分的。

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