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1 November 1997 | Volume 127 Issue 9 | Pages 820-826
The final common pathway for most systematic reviews is a statistical summary of the data, or meta-analysis. The complex methods used in meta-analyses should always be complemented by clinical acumen and common sense in designing the protocol of a systematic review, deciding which data can be combined, and determining whether data should be combined. Both continuous and binary data can be pooled. Most meta-analyses summarize data from randomized trials, but other applications, such as the evaluation of diagnostic test performance and observational studies, have also been developed. The statistical methods of meta-analysis aim at evaluating the diversity (heterogeneity) among the results of different studies, exploring and explaining observed heterogeneity, and estimating a common pooled effect with increased precision. Fixed-effects models assume that an intervention has a single true effect, whereas random-effects models assume that an effect may vary across studies. Meta-regression analyses, by using each study rather than each patient as a unit of observation, can help to evaluate the effect of individual variables on the magnitude of an observed effect and thus may sometimes explain why study results differ. It is also important to assess the robustness of conclusions through sensitivity analyses and a formal evaluation of potential sources of bias, including publication bias and the effect of the quality of the studies on the observed effect.
Author and Article Information
From New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts.
ACADEMIA AND CLINIC
SYSTEMATIC REVIEW SERIES
Series Editors: Cynthia Mulrow, MD, MSc and Deborah Cook, MD, MSc
Quantitative Synthesis in Systematic Reviews
For definitions of terms used, see Glossary at end of text.
Acknowledgments: The authors thank Drs. Andrew Oxman and Larry V. Hedges for their reviews of and valuable comments on the manuscript and thank the clinical reviewer, Norman J. Wilder.
Grant Support: In part by grants R01 HS07782 and R01 HS 08532 from the Agency for Health Care Policy and Research (Drs. Lau and Schmid) and grant T32 AI07389 from the National Institutes of Health (Dr. Ioannidis).
Current Author Addresses: Drs. Lau and Schmid: Division of Clinical Care Research, New England Medical Center, 750 Washington Street, Box 63, Boston, MA 02111.
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