The influence of methodologic quality on the conclusion of a landmark meta-analysis on thrombolytic therapy.
OBJECTIVE
We studied the influence of the methodologic quality of individual trials on the outcome of a landmark meta-analysis on thrombolytic therapy in acute myocardial infarction. From each study we extracted the number of patients in both groups who died in hospital or during follow-up. Methodologic quality was assessed using the Delphi list. We first recalculated pooled odds ratios (ORs) and 95% confidence intervals (CIs), on the studies found and compared them with the original results of Yusuf et al. Next we incorporated the results of quality assessment in five different ways in the calculation of the pooled ORs: a) component analysis; b) visual plot; c) quality score as a threshold score; d) quality score as a weighting factor; and e) cumulative pooling.


CONCLUSIONS
No correlation between quality scores and ORs was found. Studies with a proper description of the different quality components provided an estimate close to the true treatment effect. No major differences were found between the results of the five different methods of incorporating the quality scores into the final conclusion.
Verhagen
Arianne P
AP
Maastricht University.
de Vet
Henrica C W
HC
Vermeer
Frank
F
Widdershoven
Jos W M G
JW
de Bie
Robert A
RA
Kessels
Alphons G H
AG
Boers
Maarten
M
van den Brandt
Piet A
PA
D000368:Aged; D003697:Delphi Technique; D005260:Female; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D015912:Thrombolytic Therapy