title: Use of quality assessment tools in systematic reviews was varied and inconsistent.
abstract: OBJECTIVE
  To assess the use of quality assessment tools among a cross-section of systematic reviews (SRs) and to further evaluate whether quality was used as a parameter in the decision to include primary studies within subsequent meta-analysis.
  
  
  METHODS
  We searched PubMed for SRs (interventional, observational, and diagnostic) published in Core Clinical Journals between January 1 and March 31, 2014.
  
  
  RESULTS
  Three hundred nine SRs were identified. Quality assessment was undertaken in 222 (71.8%) with isolated use of the Cochrane risk of bias tool (26.1%, n = 58) and the Newcastle-Ottawa Scale (15.3%, n = 34) most common. A threshold level of primary study quality for subsequent meta-analysis was used in 12.9% (40 of 309) of reviews. Overall, fifty-four combinations of quality assessment tools were identified with a similar preponderance of tools used among observational and interventional reviews. Multiple tools were used in 11.7% (n = 36) of SRs overall.
  
  
  CONCLUSIONS
  We found that quality assessment tools were used in a majority of SRs; however, a threshold level of quality for meta-analysis was stipulated in just 12.9% (n = 40). This cross-sectional analysis provides further evidence of the need for more active or intuitive editorial processes to enhance the reporting of SRs.
authors.affiliation: Dental Institute Kings College London, Department of Orthodontics, Denmark Hill, London, SE5 9RS, United Kingdom. Electronic address: jad_seehra@hotmail.com.
authors.forename: Jadbinder
authors.initials: J
authors.lastname: Seehra
authors.affiliation: Department of Orthodontics and Dentofacial Orthopedics, Dental School/Medical Faculty, University of Bern, Freiburgstrasse 7 CH-3010, Bern, Switzerland.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Pandis
authors.affiliation: Department of Orthodontics, Dental School, University of Athens and Private Practice, 2 Thivon str, 11527 Goudi, Athens, Greece.
authors.forename: Despina
authors.initials: D
authors.lastname: Koletsi
authors.affiliation: Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Turner St., London E1 2 AD, United Kingdom.
authors.forename: Padhraig S
authors.initials: PS
authors.lastname: Fleming
mesh_terms: D015982:Bias; D000068598:Data Accuracy; D015201:Meta-Analysis as Topic; D012196:Review Literature as Topic
keywords: Meta-analysis; Quality assessment; Review; Risk of bias; Systematic; Threshold