Do trials reduce uncertainty? Assessing impact through cumulative meta-analysis of neonatal RCTs
| Autor: | C. Viner, Wenyang Mao, Haresh Kirpalani, Dmitry Dukhovny, John A.F. Zupancic, Roger F. Soll, Sara B. DeMauro, Susanne Hay, Jochen Profit |
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| Rok vydání: | 2017 |
| Předmět: |
Logistic regression
law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Meta-Analysis as Topic law 030225 pediatrics Statistical significance Outcome Assessment Health Care Confidence Intervals Medicine Humans 030212 general & internal medicine Point estimation Randomized Controlled Trials as Topic business.industry Uncertainty Obstetrics and Gynecology Odds ratio Confidence interval Review Literature as Topic Logistic Models Meta-analysis Relative risk Pediatrics Perinatology and Child Health Neonatology business Demography |
| Zdroj: | Journal of perinatology : official journal of the California Perinatal Association. 37(11) |
| ISSN: | 1476-5543 |
| Popis: | OBJECTIVE To assess the impact of the latest randomized controlled trial (RCT) to each systematic review (SR) in Cochrane Neonatal Reviews. STUDY DESIGN We selected meta-analyses reporting the typical point estimate of the risk ratio for the primary outcome of the latest study (n=130), mortality (n=128) and the mean difference for the primary outcome (n=44). We employed cumulative meta-analysis to determine the typical estimate after each trial was added, and then performed multivariable logistic regression to determine factors predictive of study impact. RESULTS For the stated primary outcome, 18% of latest RCTs failed to narrow the confidence interval (CI), and 55% failed to decrease the CI by ⩾20%. Only 8% changed the typical estimate directionality, and 11% caused a change to or from significance. Latest RCTs did not change the typical estimate in 18% of cases, and only 41% changed the typical estimate by at least 10%. The ability to narrow the CI by >20% was negatively associated with the number of previously published RCTs (odds ratio 0.707). Similar results were found in analysis of typical estimates for the outcomes of mortality and mean difference. CONCLUSION Across a broad range of clinical questions, the latest RCT failed to substantially narrow the CI of the typical estimate, to move the effect estimate or to change its statistical significance in a majority of cases. Investigators and grant peer review committees should consider prioritizing less-studied topics or requiring formal consideration of optimal information size based on extant evidence in power calculations. |
| Databáze: | OpenAIRE |
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