Abstract
IntroductionMeta-analyses have been suggested to be the highest form of evidence available to clinicians to guide clinical practice in critical care. The purpose of this study was to systematically evaluate the quality of meta-analyses that address topics pertinent to critical care.MethodsTo identify potentially eligible meta-analyses for inclusion, a systematic search of Medline, EMBASE and the Cochrane Database of Systematic Reviews was undertaken, using broad search terms relevant to intensive care, including: intensive care, critical care, shock, resuscitation, inotropes and mechanical ventilation. Predetermined inclusion criteria were applied to each identified meta-analysis independently by two authors. To assess report quality, the included meta-analyses were assessed using the component and overall scores from the Overview Quality Assessment Questionnaire (OQAQ). The quality of reports published before and after the publication of the QUOROM statement was compared.ResultsA total of 139 reports of meta-analyses were included (kappa = 0.93). The overall quality of reports of meta-analyses was found to be poor, with an estimated mean overall OQAQ score of 3.3 (95% CI; 3.0–3.6). Only 43 (30.9%) were scored as having minimal or minor flaws (>5). We noted problems with the reporting of key characteristics of meta-analyses, such as performing a thorough literature search, avoidance of bias in the inclusion of studies and appropriately referring to the validity of the included studies. After the release of the QUOROM statement, however, an improvement in the overall quality of published meta-analyses was noted.ConclusionThe overall quality of the reports of meta-analyses available to critical care physicians is poor. Physicians should critically evaluate these studies prior to considering applying the results of these studies in their clinical practice.
Highlights
Meta-analyses have been suggested to be the highest form of evidence available to clinicians to guide clinical practice in critical care
The reports of meta-analyses were published in a wide variety of sources, with the majority of reports being published in sources that were not classified as critical care journals
The overall quality meta-analyses in the critical care literature Agreement was reached on the scoring of all component scores and the overall quality scores without the need for resort to a third reviewer
Summary
Meta-analyses have been suggested to be the highest form of evidence available to clinicians to guide clinical practice in critical care. The purpose of this study was to systematically evaluate the quality of meta-analyses that address topics pertinent to critical care. One of the challenges that faces critical care physicians is staying up to date with the current state of knowledge, in a field that has a broad scope of practice and time dependency for many of the interventions provided. Systematic reviews in general, and meta-analyses in particular, have been suggested as one solution to this problem [3]. Some authorities have suggested that systematic reviews and meta-analyses are the highest form of published evidence available to clinicians [4]. OQAQ = Overview Quality Assessment Questionnaire; QUOROM = Quality of Reporting of Meta-analyses; RCT = randomised clinical trial.
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