Meta-Analysis
Background
Important medical questions are typically studied more
than once
the results of these multiple small studies of an issue
are diverse and conflicting
The need to arrive at decisions affecting
clinical practice fostered the momentum
toward evidence-based medicine
Meta-Analysis
Statistical procedure that integrates the results
of several independent studies
The statistical analysis of a large collection of
analysis results from individual studies for the
purpose of integrating the findings
Meta-analysis is a quantitative, formal,
epidemiological study design used to
systematically assess the results of previous
research to derive conclusions
Hierarchy of Evidence
Meta-Analysis
Outcomes from a meta-analysis may include a more
precise estimate of the effect of treatment or risk factor
for disease, or other outcomes, than any individual
study
Difference between Meta-Analysis
and Systematic Review
A meta-analysis is usually the final step in a systematic
review.
All meta-analyses should ideally start with an unbiased
systematic review that incorporates articles chosen
using predetermined inclusion criteria
If the data extracted from these studies meet certain
requirements, then the data can be combined using
meta-analysis
Types of review articles
Meta-Analysis
Meta-analysis did not begin
to appear regularly in the
medical literature until the
late 1970s but since then
meta-analyses have
emerged and the growth is
exponential over time
Moreover, it has been shown
that meta-analyses are the
most frequently cited form
of clinical research.
Cumulative number of publications about meta- analysis over
time, until 17 December 2009 (results from Medline search
using text meta-analysis
PRISMA
PRISMA (Preferred Reporting Items for
Systematic Reviews and Meta-Analyses) a
system aimed at helping authors to report a wide array
of systematic review and meta-analysis that assess the
benefit and harms of a healthcare intervention.
Literature Search
Meta-analysis is characterized by a thorough and
disciplined literature search
It is important to obtain all relevant studies, because
loss of studies can lead to bias in the study.
an explicit statement of questions being addressed with
reference to participants, interventions, comparisons,
outcomes and study design (PICOS) should be provided
Published papers and abstracts are identified by a
computerized literature search of electronic databases
that can include :
PubMed ([Link]./en-trez/[Link])
ScienceDirect ([Link]),
Scirus ([Link]/srsapp ),
ISI Web of Knowledge ([Link]
Google Scholar ([Link] and
CENTRAL (Cochrane Central Register of Controlled Trials,
[Link]
[Link]/cochrane/cochrane_clcentral_articles_fs
.htm).
PRISMA statement recommends that a full electronic
search strategy for at least one major database to be
presented
Database searches should be augmented with hand
searches of library resources for relevant papers, books,
abstracts, and conference proceedings.
Cross-checking of references, citations in review papers,
and communication with scientists who have been
working in the relevant field are important methods
used to provide a comprehensive search.
Inclusion or Exclusion Criteria
and Potential for Bias
Studies are chosen for meta-analysis based on inclusion
criteria.
If there is more than one hypothesis to be tested,
separate selection criteria should be defined for each
hypothesis.
When studies are excluded from a meta-analysis,
reasons for exclusion should be provided for each
excluded study.
Statistical Analysis
The most common measures are the risk ratio (also
called relative risk) and the odds ratio.
PRISMA
2009 Flow
Diagram
(From Moher D, Liberati
A, Tetzlaff J, Altman DG;
PRISMA Group.
Preferred reporting
items for systematic
reviews and metaanalyses: the PRISMA
statement. J Clin
Epidemiol
2009;62:1006-12, For
Checklist of items to include when reporting a
systematic review or meta-analysis
Checklist of items to include when reporting a
systematic review or meta-analysis (2)
Appraisal of a MetaAnalysis
Methodology
Checklist
:
Systematic
Reviews and Metaanalyses
