Reporting, handling and assessing the risk of bias associated with missing participant data in systematic reviews: A methodological survey
Por:
Akl E.A., Carrasco-Labra A., Brignardello-Petersen R., Neumann I., Johnston B.C., Sun X., Briel M., Busse J.W., Ebrahim S., Granados C.E., Iorio A., Irfan A., García L.M., Mustafa R.A., Ramírez-Morera A., Selva A., Solà I., Sanabria A.J., Tikkinen K.A.O., Vandvik P.O., Vernooij R.W.M., Zazueta O.E., Zhou Q., Guyatt G.H., Alonso-Coello P.
Publicada:
1 ene 2015
Resumen:
Objectives: To describe how systematic reviewers are reporting missing data for dichotomous outcomes, handling them in the analysis and assessing the risk of associated bias. Methods: We searched MEDLINE and the Cochrane Database of Systematic Reviews for systematic reviews of randomised trials published in 2010, and reporting a meta-analysis of a dichotomous outcome. We randomly selected 98 Cochrane and 104 non-Cochrane systematic reviews. Teams of 2 reviewers selected eligible studies and abstracted data independently and in duplicate using standardised, piloted forms with accompanying instructions. We conducted regression analyses to explore factors associated with using complete case analysis and with judging the risk of bias associated with missing participant data. Results: Of Cochrane and non-Cochrane reviews, 47% and 7% (p<0.0001), respectively, reported on the number of participants with missing data, and 41% and 9% reported a plan for handling missing categorical data. The 2 most reported approaches for handling missing data were complete case analysis (8.5%, out of the 202 reviews) and assuming no participants with missing data had the event (4%). The use of complete case analysis was associated only with Cochrane reviews (relative to non-Cochrane: OR=7.25; 95% CI 1.58 to 33.3, p=0.01). 65% of reviews assessed risk of bias associated with missing data; this was associated with Cochrane reviews (relative to non-Cochrane: OR=6.63; 95% CI 2.50 to 17.57, p=0.0001), and the use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology (OR=5.02; 95% CI 1.02 to 24.75, p=0.047). Conclusions: Though Cochrane reviews are somewhat less problematic, most Cochrane and non-Cochrane systematic reviews fail to adequately report and handle missing data, potentially resulting in misleading judgements regarding risk of bias.
Filiaciones:
Akl E.A.:
Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
Carrasco-Labra A.:
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
Evidence Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
Brignardello-Petersen R.:
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
Evidence Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
Neumann I.:
Department of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
Johnston B.C.:
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada
Sun X.:
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
Clinical Research and Evaluation Unit, Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
Briel M.:
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
Busse J.W.:
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
Department of Anesthesia, McMaster University, HamiltonON, Canada
Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
Ebrahim S.:
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
Department of Anesthesia, McMaster University, HamiltonON, Canada
Department of Medicine, Stanford Prevention Research Center, Stanford University, Palo Alto, CA, United States
Granados C.E.:
Área de Investigaciones, Facultad de Medicina, Universidad de la Sabana, Chía, Colombia
Iorio A.:
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
Department of Medicine, McMaster University, Hamilton, ON, Canada
Irfan A.:
Department of Cardiology, University of Louisville, Louisville, KY, United States
García L.M.:
Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health, Barcelona, Spain
Mustafa R.A.:
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
Departments of Medicine, Nephrology and Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, MO, United States
Ramírez-Morera A.:
Health Care Development Division, IHCAI Foundation and Central America Cochrane, San José, Costa Rica
Selva A.:
Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health, Barcelona, Spain
Solà I.:
Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health, Barcelona, Spain
Sanabria A.J.:
Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health, Barcelona, Spain
Tikkinen K.A.O.:
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
Departments of Urology and Public Health, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
Vandvik P.O.:
Norwegian Knowledge Centre for the Health Services, Oslo, Norway
Department of Medicine, Innlandet Hospital Trust, Gjøvik, Norway
Vernooij R.W.M.:
Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health, Barcelona, Spain
Zazueta O.E.:
Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health, Barcelona, Spain
Zhou Q.:
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
Guyatt G.H.:
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
Department of Medicine, McMaster University, Hamilton, ON, Canada
Alonso-Coello P.:
Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health, Barcelona, Spain
All Open Access, Gold
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