Chauhan Suneet P, Hammad Ibrahim A, Weyer Katherine L, Ananth Cande V
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center, Houston, Texas.
Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia.
Am J Perinatol. 2016 Apr;33(5):442-8. doi: 10.1055/s-0035-1566247. Epub 2015 Nov 2.
The objectives of this review are to (1) ascertain the frequency with which odd ratio (OR) and relative risk (RR) are in the zone of potential bias or interest in the American College of Obstetricians and Gynecologists (ACOG) practice bulletins (PB); (2) the likelihood that false alarms have been linked to recommendations; and (3) if there are differences in obstetric versus gynecological PB, vis-à-vis OR and RR in the zone of bias or interest.
We reviewed all ACOG PBs published between May 1999 and March 2014.
Documents were searched for statements with mention of OR and RR. When the reported ORs fell between 0.33 and 3.0, it was categorized as "zone of potential bias"; if ORs fell outside the interval 0.25 to 4.0, it was "zone of potential interest." With RRs, the zones of bias and interest were 0.5 to 2.0 and 0.33 to 3.0, respectively.
Of the 79 PBs reviewed, 22% (n = 17) had 44 statements with OR, with 41% (n = 18) of the ORs being in the zone of bias and 54% (n = 24) in the zone of potential interest. Overall, 84% of the ORs did not lead to an actual recommendation by ACOG. In 28% (n = 22) of PBs, there were 67 statements with RRs, with 58% (n = 39) of them being in the zone of bias and 28% (n = 19) were in the zone of interest. In 73% of the PBs the RR citations did not lead to any recommendations. Across the 79 PBs, ACOG made 733 recommendations, and among them only 1 and 2% were linked with ORs and RRs, respectively.
Over 70% of ACOGPBs did not cite OR and RR. To better understand the evidence, ACOG should increase citation of OR and RR; whenever applicable OR and RR should be part of graded recommendations.
Level C.
PRÉCIS: Less than a third of ACOG practice bulletins mention odds ratios or relative risks and over 95% of recommendations in them remain unsubstantiated.
本综述的目的是：（1）确定美国妇产科医师学会（ACOG）实践公告（PB）中比值比（OR）和相对危险度（RR）处于潜在偏倚或关注区间的频率；（2）假警报与推荐相关联的可能性；（3）产科与妇科PB在偏倚或关注区间内的OR和RR方面是否存在差异。
我们回顾了1999年5月至2014年3月期间发布的所有ACOG PB。
在文件中搜索提及OR和RR的陈述。当报告的OR值在0.33至3.0之间时，将其归类为“潜在偏倚区间”；如果OR值落在0.25至4.0区间之外，则为“潜在关注区间”。对于RR，偏倚区间和关注区间分别为0.5至2.0和0.33至3.0。
在回顾的79份PB中，22%（n = 17）有44条关于OR的陈述，其中41%（n = 18）的OR值处于偏倚区间，54%（n = 24）处于潜在关注区间。总体而言，84%的OR值并未导致ACOG给出实际推荐。在28%（n = 22）的PB中，有67条关于RR的陈述，其中58%（n = 39）处于偏倚区间，28%（n = 19）处于关注区间。在73%的PB中，RR引用并未导致任何推荐。在这79份PB中，ACOG给出了733条推荐，其中分别只有1%和2%与OR值和RR值相关联。
超过70%的ACOG PB未引用OR和RR。为了更好地理解证据，ACOG应增加对OR和RR的引用；只要适用，OR和RR应成为分级推荐的一部分。
C级。
不到三分之一的ACOG实践公告提及比值比或相对危险度，其中超过95%的推荐仍无依据。
