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01.12.2018 | Methodology | Ausgabe 1/2018 Open Access

Systematic Reviews 1/2018

Assessing imprecision in Cochrane systematic reviews: a comparison of GRADE and Trial Sequential Analysis

Zeitschrift:
Systematic Reviews > Ausgabe 1/2018
Autoren:
Greta Castellini, Matteo Bruschettini, Silvia Gianola, Christian Gluud, Lorenzo Moja
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s13643-018-0770-1) contains supplementary material, which is available to authorized users.

Abstract

Background

The evaluation of imprecision is a key dimension of the grading of the confidence in the estimate. Grading of Recommendations Assessment, Development and Evaluation (GRADE) gives recommendations on how to downgrade evidence for imprecision, but authors vary in their use. Trial Sequential Analysis (TSA) has been advocated for a more reliable assessment of imprecision. We aimed to evaluate reporting of and adherence to GRADE and to compare the assessment of imprecision of intervention effects assessed by GRADE and TSA in Cochrane systematic reviews.

Methods

In this cross-sectional study, we included 100 Cochrane reviews irrespective of type of intervention with a key dichotomous outcome meta-analyzed and assessed by GRADE. The methods and results sections of each review were assessed for adequacy of imprecision evaluation. We re-analyzed imprecision following the GRADE Handbook and the TSA Manual.

Results

Overall, only 13.0% of reviews stated the criteria they applied to assess imprecision. The most common dimensions were the 95% width of the confidence intervals and the optimal information size. Review authors downgraded 48.0% of key outcomes due to imprecision. When imprecision was re-analyzed following the GRADE Handbook, 64% of outcomes were downgraded. Agreement between review authors’ assessment and assessment by the authors of this study was moderate (kappa 0.43, 95% confidence interval [CI] 0.23 to 0.58). TSA downgraded 69.0% outcomes due to imprecision. Agreement between review authors’ GRADE assessment and TSA, irrespective of downgrading levels, was moderate (kappa 0.43, 95% CI 0.21 to 0.57). Agreement between our GRADE assessment following the Handbook and TSA was substantial (kappa 0.66, 95% CI 0.49 to 0.79).

Conclusions

In a sample of Cochrane reviews, methods for assessing imprecision were rarely reported. GRADE according to Handbook guidelines and TSA led to more severe judgment of imprecision rather than GRADE adopted by reviews’ authors. Cochrane initiatives to improve adherence to GRADE Handbook are warranted. TSA may transparently assist in such development.
Zusatzmaterial
Additional file 1: Trial Sequential Analysis as supplement of GRADE assessment for imprecision. (DOCX 13 kb)
13643_2018_770_MOESM1_ESM.docx
Additional file 2: Cochrane systematic reviews with general characteristics. (DOCX 24 kb)
13643_2018_770_MOESM2_ESM.docx
Additional file 3: Logistic regressions results. (DOCX 273 kb)
13643_2018_770_MOESM3_ESM.docx
Literatur
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