A systematic evaluation of the quality of meta-analyses in the critical care literature

Anthony Delaney¹ , Sean M Bagshaw² , Andre Ferland³, Braden Manns⁴, Kevin B Laupland⁵ and Christopher J Doig⁶

¹Staff Specialist, Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, NSW, Australia

²Fellow, Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada

³Clinical Associate Professor, Departments of Critical Care Medicine and Medicine, University of Calgary, Calgary, Alberta, Canada

⁴Assistant Professor, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

⁵Assistant Professor, Departments of Critical Care Medicine, Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

⁶Associate Professor, Departments of Critical Care Medicine, Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

author email corresponding author email

Critical Care 2005, 9:R575-R582doi:10.1186/cc3803


Published:	9 September 2005

Abstract

Introduction

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.

Methods

To 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.

Results

A 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.

Conclusion

The 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.