Bench-to-bedside review: avoiding pitfalls in critical care meta-analysis - funnel plots, risk estimates, types of heterogeneity, baseline risk and the ecologic fallacy

Reade, Michael C., Delaney, Anthony, Bailey, Michael J. and Angus, Derek C. (2008) Bench-to-bedside review: avoiding pitfalls in critical care meta-analysis - funnel plots, risk estimates, types of heterogeneity, baseline risk and the ecologic fallacy. Critical Care, 12 . doi:10.1186/cc6941


Author Reade, Michael C.
Delaney, Anthony
Bailey, Michael J.
Angus, Derek C.
Title Bench-to-bedside review: avoiding pitfalls in critical care meta-analysis - funnel plots, risk estimates, types of heterogeneity, baseline risk and the ecologic fallacy
Journal name Critical Care   Check publisher's open access policy
ISSN 1364-8535
1466-609X
Publication date 2008-07-25
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1186/cc6941
Open Access Status DOI
Volume 12
Total pages 8
Place of publication Philadelphia, PA, United States
Publisher Current Science
Language eng
Abstract Meta-analysis can be a powerful tool for demonstrating the applicability of a concept beyond the context of individual clinical trials and observational studies, including exploration of effects across different subgroups. Meta-analysis avoids Simpson's paradox, in which a consistent effect in constituent trials is reversed when results are simply pooled. Meta-analysis in critical care medicine is made more complicated, however, by the heterogeneous nature of critically ill patients and the contexts within which they are treated. Failure to properly adjust for this heterogeneity risks missing important subgroup effects in, for example, the interaction of treatment with varying levels of baseline risk. When subgroups are defined by characteristics that vary within constituent trials (such as age) rather than features constant within each trial (such as drug dose), there is the additional risk of incorrect conclusions due to the ecological fallacy. The present review explains these problems and the strategies by which they are overcome.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
 
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