Small studies may overestimate the effect sizes in critical care meta-analyses a meta-epidemiological study 英文参考文献.docVIP

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Small studies may overestimate the effect sizes in critical care meta-analyses a meta-epidemiological study 英文参考文献.doc

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Small studies may overestimate the effect sizes in critical care meta-analyses a meta-epidemiological study 英文参考文献

Zhangetal.CriticalCare2013,17:R2 /content/17/1/R2 RESEARCH OpenAccess Smallstudiesmayoverestimatetheeffectsizesin criticalcaremeta-analyses:ameta- epidemiologicalstudy ZhonghengZhang*,XiaoXuandHongyingNi Abstract Introduction:Small-studyeffectsrefertothefactthattrialswithlimitedsamplesizesaremorelikelytoreport largerbeneficialeffectsthanlargetrials.However,thishasneverbeeninvestigatedincriticalcaremedicine.Thus, thepresentstudyaimedtoexaminethepresenceandextentofsmall-studyeffectsincriticalcaremedicine. Methods:Criticalcaremeta-analysesinvolvingrandomizedcontrolledtrialsandreportedmortalityasanoutcome measurewereconsideredeligibleforthestudy.Componenttrialswereclassifiedaslarge(≥100patientsperarm) andsmall(100patientsperarm)accordingtotheirsamplesizes.Ratioofoddsratio(ROR)wascalculatedfor eachmeta-analysisandthenRORswerecombinedusingameta-analyticapproach.ROR1indicatedlarger beneficialeffectinsmalltrials.Smallandlargetrialswerecomparedinmethodologicalqualitiesincluding sequencegenerating,blinding,allocationconcealment,intentiontotreatandsamplesizecalculation. Results:Atotalof27criticalcaremeta-analysesinvolving317trialswereincluded.Ofthem,fivemeta-analyses showedstatisticallysignificantRORs1,andothermeta-analysesdidnotreachastatisticalsignificance.Overall,the pooledRORwas0.60(95%CI:0.53to0.68);theheterogeneitywasmoderatewithanI2of50.3%(chi-squared= 52.30;P=0.002).Largetrialsshowedsignificantlybetterreportingqualitythansmalltrialsintermsofsequence generating,allocationconcealment,blinding,intentiontotreat,samplesizecalculationandincompletefollow-up data. Conclusions:Smalltrialsaremorelikelytoreportlargerbeneficialeffectsthanlargetrialsincriticalcaremedicine, whichcouldbepartlyexplainedbythelowermethodologicalqualityinsmalltrials.Cautionshouldbepracticedin theinterpretationofmeta-analysesinvolvingsmalltrials. Introduction topoftheplot,makingittheshapeofaninvertedfunnel Small-studyeffectsrefertothepatternthatsmallstudies plot. Ifafunnel plotappears asymmetrical