Cochrane Sustainable Healthcare, Hedegatan 38, Uddevalla 45152, Sweden; Cochrane Sweden, Skåne University Hospital, Wigerthuset, Remissgatan 4, Lund 222 42, Sweden.
Cochrane Sweden, Skåne University Hospital, Wigerthuset, Remissgatan 4, Lund 222 42, Sweden.
J Clin Epidemiol. 2021 Jan;129:68-73. doi: 10.1016/j.jclinepi.2020.09.030. Epub 2020 Oct 1.
To investigate if Cochrane reviews that assess screening interventions address their major harms.
A systematic search for Cochrane reviews that assess screening interventions was performed. Two authors independently screened abstracts, assessed full-texts, and extracted data from included reviews. For each review, two authors judged whether each predefined harm was relevant. When the harm was judged as of questionable relevance, the review was excluded from the denominator in our calculations.
Forty-seven reviews were included. Overdiagnosis was addressed in 6 of 39 (15%), overtreatment in 7 of 43 (16%), and psychosocial consequences in 30 of 47 (64%) of reviews where this was judged relevant. When data on harms were included, they were generally not treated with the same methodological rigor as the benefits, with no assessment of the risk of bias or certainty of the evidence. About half of the Abstracts, Plain Language Summaries, and Summary of Findings tables did not include any harms.
The underreporting of harms of screening in Cochrane reviews likely reflects primary research and is problematic. We call for broad collaboration to develop reporting guidelines and core outcome sets for studies of screening interventions.
调查评估筛查干预措施的 Cochrane 综述是否涉及主要危害。
对评估筛查干预措施的 Cochrane 综述进行了系统搜索。两位作者独立筛选摘要、评估全文并从纳入的综述中提取数据。对于每篇综述，两位作者判断每个预先定义的危害是否相关。当危害被判断为相关性值得怀疑时，该综述将从我们的计算中排除。
共纳入 47 篇综述。39 篇综述中有 6 篇（15%）涉及过度诊断，43 篇综述中有 7 篇（16%）涉及过度治疗，47 篇综述中有 30 篇（64%）判断与心理社会后果相关。当涉及危害的数据被纳入时，它们通常没有像评估益处那样采用相同的方法学严谨性，也没有评估偏倚风险或证据的确定性。大约一半的摘要、通俗易懂的摘要和发现总结表没有包含任何危害。
Cochrane 综述中筛查危害的报告不足可能反映了初级研究，这是有问题的。我们呼吁广泛合作，制定用于筛查干预研究的报告指南和核心结局集。
