Semmes-Murphey Neurologic & Spine Institute;
J Neurosurg. 2014 Apr;120(4):796-810. doi: 10.3171/2013.11.JNS13195. Epub 2014 Jan 24.
Neurosurgeons are inundated with vast amounts of new clinical research on a daily basis, making it difficult and time-consuming to keep up with the latest literature. Meta-analysis is an extension of a systematic review that employs statistical techniques to pool the data from the literature in order to calculate a cumulative effect size. This is done to answer a clearly defined a priori question. Despite their increasing popularity in the neurosurgery literature, meta-analyses have not been scrutinized in terms of reporting and methodology.
The authors performed a literature search using PubMed/MEDLINE to locate all meta-analyses that have been published in the JNS Publishing Group journals (Journal of Neurosurgery, Journal of Neurosurgery: Pediatrics, Journal of Neurosurgery: Spine, and Neurosurgical Focus) or Neurosurgery. Accepted checklists for reporting (PRISMA) and methodology (AMSTAR) were applied to each meta-analysis, and the number of items within each checklist that were satisfactorily fulfilled was recorded. The authors sought to answer 4 specific questions: Are meta-analyses improving 1) with time; 2) when the study met their definition of a meta-analysis; 3) when clinicians collaborated with a potential expert in meta-analysis; and 4) when the meta-analysis was the only focus of the paper?
Seventy-two meta-analyses were published in the JNS Publishing Group journals and Neurosurgery between 1990 and 2012. The number of published meta-analyses has increased dramatically in the last several years. The most common topics were vascular, and most were based on observational studies. Only 11 papers were prepared using an established checklist. The average AMSTAR and PRISMA scores (proportion of items satisfactorily fulfilled divided by the total number of eligible items in the respective instrument) were 31% and 55%, respectively. Major deficiencies were identified, including the lack of a comprehensive search strategy, study selection and data extraction, assessment of heterogeneity, publication bias, and study quality. Almost one-third of the papers did not meet our basic definition of a meta-analysis. The quality of reporting and methodology was better 1) when the study met our definition of a meta-analysis; 2) when one or more of the authors had experience or expertise in conducting a meta-analysis; 3) when the meta-analysis was not conducted alongside an evaluation of the authors' own data; and 4) in more recent studies.
Reporting and methodology of meta-analyses in the neurosurgery literature is excessively variable and overall poor. As these papers are being published with increasing frequency, neurosurgical journals need to adopt a clear definition of a meta-analysis and insist that they be created using checklists for both reporting and methodology. Standardization will ensure high-quality publications.
神经外科医生每天都会接触到大量新的临床研究，因此很难跟上最新文献的进展。荟萃分析是系统综述的延伸，它运用统计学技术汇总文献中的数据，以计算累积效应大小。这样做是为了回答一个明确界定的先验问题。尽管荟萃分析在神经外科学文献中的应用越来越广泛，但它们在报告和方法学方面尚未受到仔细审查。
作者使用 PubMed/MEDLINE 进行文献检索，以定位在 JNS 出版集团期刊（《神经外科杂志》《神经外科：儿科杂志》《神经外科：脊柱杂志》和《神经外科焦点》）或《神经外科》上发表的所有荟萃分析。应用了接受的报告检查表（PRISMA）和方法学检查表（AMSTAR），记录了每个检查表中满意完成的项目数量。作者试图回答 4 个具体问题：荟萃分析是否在以下方面有所改进：1）随着时间的推移；2）当研究符合他们对荟萃分析的定义时；3）当临床医生与潜在的荟萃分析专家合作时；4）当荟萃分析是论文唯一重点时？
1990 年至 2012 年，JNS 出版集团期刊和《神经外科》共发表了 72 篇荟萃分析。近年来，发表的荟萃分析数量显著增加。最常见的主题是血管，而且大多数都是基于观察性研究。只有 11 篇论文是使用既定清单编写的。平均 AMSTAR 和 PRISMA 评分（满意完成的项目数与各自工具中合格项目总数的比例）分别为 31%和 55%。存在重大缺陷，包括缺乏全面的搜索策略、研究选择和数据提取、异质性评估、发表偏倚和研究质量。近三分之一的论文不符合我们对荟萃分析的基本定义。当研究符合我们对荟萃分析的定义时、当作者中有一人或多人具有进行荟萃分析的经验或专业知识时、当荟萃分析不是与作者自己数据的评估同时进行时、以及在最近的研究中，报告和方法学的质量更好。
神经外科学文献中的荟萃分析报告和方法学存在很大差异，整体质量较差。随着这些论文的发表频率越来越高，神经外科学期刊需要采用荟萃分析的明确定义，并坚持使用报告和方法学检查表进行创建。标准化将确保高质量的出版物。
