Abstract:
OBJECTIVE:To assess the risk of bias associated with missing outcome data in systematic reviews. DESIGN:Imputation study. SETTING:Systematic reviews. POPULATION:100 systematic reviews that included a group level meta-analysis with a statistically significant effect on a patient important dichotomous efficacy outcome. MAIN OUTCOME MEASURES:Median percentage change in the relative effect estimate when applying each of the following assumption (four commonly discussed but implausible assumptions (best case scenario, none had the event, all had the event, and worst case scenario) and four plausible assumptions for missing data based on the informative missingness odds ratio (IMOR) approach (IMOR 1.5 (least stringent), IMOR 2, IMOR 3, IMOR 5 (most stringent)); percentage of meta-analyses that crossed the threshold of the null effect for each method; and percentage of meta-analyses that qualitatively changed direction of effect for each method. Sensitivity analyses based on the eight different methods of handling missing data were conducted. RESULTS:100 systematic reviews with 653 randomised controlled trials were included. When applying the implausible but commonly discussed assumptions, the median change in the relative effect estimate varied from 0% to 30.4%. The percentage of meta-analyses crossing the threshold of the null effect varied from 1% (best case scenario) to 60% (worst case scenario), and 26% changed direction with the worst case scenario. When applying the plausible assumptions, the median percentage change in relative effect estimate varied from 1.4% to 7.0%. The percentage of meta-analyses crossing the threshold of the null effect varied from 6% (IMOR 1.5) to 22% (IMOR 5) of meta-analyses, and 2% changed direction with the most stringent (IMOR 5). CONCLUSION:Even when applying plausible assumptions to the outcomes of participants with definite missing data, the average change in pooled relative effect estimate is substantive, and almost a quarter (22%) of meta-analyses crossed the threshold of the null effect. Systematic review authors should present the potential impact of missing outcome data on their effect estimates and use this to inform their overall GRADE (grading of recommendations assessment, development, and evaluation) ratings of risk of bias and their interpretation of the results.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Kahale LA,Khamis AM,Diab B,Chang Y,Lopes LC,Agarwal A,Li L,Mustafa RA,Koujanian S,Waziry R,Busse JW,Dakik A,Schünemann HJ,Hooft L,Scholten RJ,Guyatt GH,Akl EAdoi
10.1136/bmj.m2898subject
Has Abstractpub_date
2020-08-26 00:00:00pages
m2898eissn
0959-8138issn
1756-1833journal_volume
370pub_type
杂志文章,评审abstract::The numbers of patients being admitted to hospital with aortic aneurysms have increased recently. A study was carried out to try to find out whether this was a true increase in incidence or whether it could be attributable to more accurate diagnosis and better surgical techniques. From analyses of routine statistics i...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
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更新日期:1989-01-07 00:00:00
abstract:OBJECTIVES:To examine how insurance companies assess proposals for life assurance from applicants with raised cholesterol concentrations and to determine the excess mortality rating applied. DESIGN:Survey of 49 companies underwriting term life assurance. SETTING:United Kingdom. SUBJECTS:Four fictional men aged 30 se...
journal_title:BMJ (Clinical research ed.)
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journal_title:BMJ (Clinical research ed.)
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.f4240
更新日期:2013-07-23 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2010-04-20 00:00:00
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更新日期:2009-03-12 00:00:00
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更新日期:2013-11-04 00:00:00
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doi:10.1136/bmj.302.6768.82
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pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:1993-10-23 00:00:00
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更新日期:2001-02-24 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
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更新日期:1995-05-20 00:00:00
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更新日期:2010-03-23 00:00:00
abstract::The studyA Rodger, V Cambiano, T Bruun, et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet 2019;393:2428-38.This project was funde...
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更新日期:2019-08-27 00:00:00
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更新日期:2011-07-07 00:00:00
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更新日期:2011-02-03 00:00:00
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更新日期:2011-10-19 00:00:00
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