Klinik für Kinder- und Jugendmedizin, Elisabeth-Krankenhaus, Essen, Germany.
Klinik für Kinder- und Jugendmedizin, Klinikum Dortmund, Dortmund, Germany.
Pediatr Surg Int. 2021 Mar;37(3):363-367. doi: 10.1007/s00383-020-04827-5. Epub 2021 Jan 16.
Meta-analyses occupy the highest level of evidence and thereby guide clinical decision-making. Recently, randomised-controlled trials were evaluated for the robustness of their findings by calculating the fragility index. The fragility index is the number of events that needs to be added to one treatment arm until the statistical significance collapses. We, therefore, aimed to evaluate the robustness of paediatric surgical meta-analyses.
We searched MEDLINE for paediatric surgical meta-analyses in the last decade. All meta-analyses on a paediatric surgical condition were eligible for analysis if they based their conclusion on a statistically significant meta-analysis.
We screened 303 records and conducted a full-text evaluation of 60 manuscripts. Of them, 39 were included in our analysis that conducted 79 individual meta-analyses with significant results. Median fragility index was 5 (Q25-Q75% 2-11). Median fragility in relation to included patients was 0.77% (Q25-Q75% 0.29-1.87%).
Paediatric surgical meta-analyses are often fragile. In almost 60% of results, the statistical significance depends on less than 1% of the included population. However, as the fragility index is just a transformation of the P value, it basically conveys the same information in a different format. It therefore should be avoided.
荟萃分析处于证据的最高级别，从而指导临床决策。最近，通过计算脆弱指数来评估随机对照试验结果的稳健性。脆弱指数是需要添加到一个治疗组中的事件数量，直到统计显著性崩溃。因此，我们旨在评估儿科外科荟萃分析的稳健性。
我们在过去十年中搜索了 MEDLINE 上的儿科外科荟萃分析。如果基于统计学显著荟萃分析得出结论，则所有针对儿科外科疾病的荟萃分析均有资格进行分析。
我们筛选了 303 条记录，并对 60 篇全文进行了评估。其中，39 篇被纳入我们的分析，该分析进行了 79 项具有显著结果的个别荟萃分析。中位数脆弱指数为 5（Q25-Q75% 2-11）。与纳入患者相关的中位数脆弱性为 0.77%（Q25-Q75% 0.29-1.87%）。
儿科外科荟萃分析往往很脆弱。在近 60%的结果中，统计显著性取决于纳入人群的不到 1%。然而，由于脆弱指数只是 P 值的一种转换，它基本上以不同的格式传达相同的信息。因此，应避免使用。
