Carson C A, Fine M J, Smith M A, Weissfeld L A, Huber J T, Kapoor W N
Department of Epidemiology, University of Pittsburgh, PA 15213.
J Gen Intern Med. 1994 Jan;9(1):13-9. doi: 10.1007/BF02599136.
To systematically assess the quality of published reports of the prognosis of community-acquired pneumonia using a formal quality assessment instrument.
Retrospective review of studies published during 1966-1991. ARTICLES: 108 articles related to the prognosis of community-acquired pneumonia retrieved by a computerized search.
All articles, blinded to author(s), journal title, year of publication, and study institution(s), were independently reviewed by two investigators using a ten-item quality assessment instrument designed to evaluate: 1) identification of the inception cohort (4 items), 2) description of referral patterns (1 item), 3) subject follow-up (2 items), and 4) statistical methods (3 items). Adherence to each of the ten individual quality items and an overall quality score were calculated for all articles and across three time periods.
Among all 108 articles that underwent quality assessment, 30 were published from 1966 to 1979, 61 from 1980 through 1989, and 17 from 1990 through 1991. The mean total quality score of all articles was 0.55 (range 0.22-0.90). There was a significant trend toward improvement in total quality scores over the three time periods (0.50 to 0.56 to 0.65; p < 0.001). However, several systematic errors in the study design or reporting of these studies were discovered throughout time: only 3.7% provided comparative information about nonenrolled patients, 28.7% determined whether the study institution was a referral center, 36.1% specified inclusion or exclusion criteria, and 45.5% used appropriate statistical analyses to adjust for more than one prognostic factor.
Despite improvement in overall quality of published articles, systematic errors exist in the design and reporting of studies related to the prognosis of community-acquired pneumonia. The quality assessment tool employed in this study could be used to guide the development of high-quality outcomes research in the future.
使用正式的质量评估工具系统评价已发表的社区获得性肺炎预后报告的质量。
对1966年至1991年期间发表的研究进行回顾性分析。
通过计算机检索获得108篇与社区获得性肺炎预后相关的文章。
两名研究者对所有文章进行独立评审，评审时对作者、期刊名称、发表年份和研究机构进行盲法处理，使用一个包含10项内容的质量评估工具来评估：1）起始队列的确定（4项），2）转诊模式的描述（1项），3）受试者随访（2项），4）统计方法（3项）。计算所有文章以及三个时间段内每项质量指标的符合情况和总体质量得分。
在接受质量评估的108篇文章中，30篇发表于1966年至1979年，61篇发表于1980年至1989年，17篇发表于1990年至1991年。所有文章的平均总体质量得分为0.55（范围0.22 - 0.90）。在这三个时间段内总体质量得分有显著的改善趋势（0.50至0.56至0.65；p < 0.001）。然而，在整个时间段内发现了这些研究在设计或报告方面的一些系统性错误：仅3.7%提供了未纳入患者的比较信息，28.7%确定研究机构是否为转诊中心，36.1%明确了纳入或排除标准，45.5%使用了适当的统计分析来调整多个预后因素。
尽管已发表文章的总体质量有所提高，但与社区获得性肺炎预后相关的研究在设计和报告方面仍存在系统性错误。本研究中使用的质量评估工具可用于指导未来高质量结局研究的开展。
