An exact test for meta-analysis with binary endpoints.
OBJECTIVE
We reintroduce an exact Mantel-Haenszel (MH) procedure for meta-analysis with binary endpoints which is expected to work especially well in sparse data, e.g., in meta-analyses of safety or adverse events.


METHODS
The performance of the exact MH procedure in terms of empirical size and power is compared to the asymptotic MH and to the two standard procedures (fixed effects and random effects model) in a simulation study. We illustrate the methods with a meta-analysis of postoperative stroke occurrence after off-pump or on-pump surgery in coronary artery bypass grafting.


RESULTS
We find that in almost all situations the asymptotic MH procedure outperforms its competitors; especially the standard methods yield poor results in terms of power and size.


CONCLUSIONS
There is no need to use the reintroduced exact MH procedure; the asymptotic MH procedure will be sufficient in most practical situations. The standard methods (fixed effects and random effects model) should not be used in the sparse data situation.
Kuss
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Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Str. 27, 06097 Halle (Saale), Germany. Oliver.Kuss@medizin.uni-halle.de
Gromann
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D003198:Computer Simulation; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003627:Data Interpretation, Statistical; D006801:Humans; D016015:Logistic Models; D015201:Meta-Analysis as Topic; D015233:Models, Statistical; D016017:Odds Ratio; D012307:Risk Factors; D020521:Stroke / Q000209:etiology