系统评价在报告绝对效应方面存在重大局限性。
Systematic reviews experience major limitations in reporting absolute effects.
作者信息
Alonso-Coello Pablo, Carrasco-Labra Alonso, Brignardello-Petersen Romina, Neumann Ignacio, Akl Elie A, Vernooij Robin W M, Johnston Brad C, Sun Xin, Briel Matthias, Busse Jason W, Ebrahim Shanil, Granados Carlos E, Iorio Alfonso, Irfan Affan, Martínez García Laura, Mustafa Reem A, Ramírez-Morera Anggie, Selva Anna, Solà Ivan, Sanabria Andrea Juliana, Tikkinen Kari A O, Vandvik Per Olav, Zazueta Oscar E, Zhang Yuqing, Zhou Qi, Schünemann Holger, Guyatt Gordon H
机构信息
Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP); Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Sergio Livingstone 943, Santiago, Chile.
出版信息
J Clin Epidemiol. 2016 Apr;72:16-26. doi: 10.1016/j.jclinepi.2015.11.002. Epub 2015 Nov 10.
OBJECTIVES
Expressing treatment effects in relative terms yields larger numbers than expressions in absolute terms, affecting the judgment of the clinicians and patients regarding the treatment options. It is uncertain how authors of systematic reviews (SRs) absolute effect estimates are reported in. We therefore undertook a systematic survey to identify and describe the reporting and methods for calculating absolute effect estimates in SRs.
STUDY DESIGN AND SETTING
Two reviewers independently screened title, abstract, and full text and extracted data from a sample of Cochrane and non-Cochrane SRs. We used regression analyses to examine the association between study characteristics and the reporting of absolute estimates for the most patient-important outcome.
RESULTS
We included 202 SRs (98 Cochrane and 104 non-Cochrane), most of which (92.1%) included standard meta-analyses including relative estimates of effect. Of the 202 SRs, 73 (36.1%) reported absolute effect estimates for the most patient-important outcome. SRs with statistically significant effects were more likely to report absolute estimates (odds ratio, 2.26; 95% confidence interval: 1.08, 4.74). The most commonly reported absolute estimates were: for each intervention, risk of adverse outcomes expressed as a percentage (41.1%); number needed to treat (26.0%); and risk for each intervention expressed as natural units or natural frequencies (24.7%). In 12.3% of the SRs that reported absolute effect estimates for both benefit and harm outcomes, harm outcomes were reported exclusively as absolute estimates. Exclusively reporting of beneficial outcomes as absolute estimates occurred in 6.8% of the SRs.
CONCLUSIONS
Most SRs do not report absolute effects. Those that do often report them inadequately, thus requiring users of SRs to generate their own estimates of absolute effects. For any apparently effective or harmful intervention, SR authors should report both absolute and relative estimates to optimize the interpretation of their findings.
目的
用相对指标来表达治疗效果得出的数值比用绝对指标得出的数值更大，这会影响临床医生和患者对治疗方案的判断。目前尚不清楚系统评价（SR）的作者是如何报告绝对效应估计值的。因此，我们进行了一项系统调查，以识别和描述SR中绝对效应估计值的报告情况及计算方法。
研究设计与设置
两名评审员独立筛选标题、摘要和全文，并从Cochrane系统评价和非Cochrane系统评价样本中提取数据。我们使用回归分析来检验研究特征与最具患者重要性结局的绝对估计值报告之间的关联。
结果
我们纳入了202篇系统评价（98篇Cochrane系统评价和104篇非Cochrane系统评价），其中大多数（92.1%）纳入了包括效应相对估计值的标准荟萃分析。在这202篇系统评价中，73篇（36.1%）报告了最具患者重要性结局的绝对效应估计值。具有统计学显著效应的系统评价更有可能报告绝对估计值（优势比，2.26；95%置信区间：1.08，4.74）。最常报告的绝对估计值为：每种干预措施的不良结局风险以百分比表示（41.1%）；需治疗人数（26.0%）；以及每种干预措施的风险以自然单位或自然频率表示（24.7%）。在报告了有益和有害结局绝对效应估计值的系统评价中，12.3%仅将有害结局报告为绝对估计值。仅将有益结局报告为绝对估计值的情况出现在6.8%的系统评价中。
结论
大多数系统评价未报告绝对效应。那些报告了绝对效应的系统评价往往报告得并不充分，因此需要系统评价的使用者自行生成绝对效应的估计值。对于任何明显有效或有害的干预措施，系统评价的作者都应报告绝对和相对估计值，以优化对研究结果的解读。
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