reporting systematic reviews christine laine, md, mph editor, annals of internal medicine

Reporting Systematic Reviews

Christine Laine, MD, MPHEditor, Annals of Internal Medicine

Elements of Well-Reported Reviews Address a good question, state it

clearlyDetailed description of search,

selection, and evaluation of evidenceDigestible reporting of available

studiesThoughtful qualitative synthesis

(even if quantitative summary)Discussion that puts findings in

context

McAlister, F. A. et. al. Ann Intern Med 1999;131:947-951

Percentage of 158 review articles published in 1996 that fulfilled specific methodologic criteria

Common ProblemsToo longInsufficient detail to permit

replicationAging searchUndigestible catalog of available

evidenceWeak qualitative synthesisInadequate handling of heterogeneityLack recognition of impending

evidence

Too longFollow instructionsJudicious use of tables and

figuresProvide technical material in

appendicesVery brief introFocussed discussion

Follow PRISMA checklistTechnical appendices

Insufficient detail

Summary of evidence search and selection.

Bloomfield H E et al. Ann Intern Med 2011;154:472-482

©2011 by American College of Physicians

Advise that end date of search be 3-6 months prior to submission

Bridge searches if necessaryImportance of currency of search

can be very topic-dependent

Aging Search

Judicious use of tables and figures

Qualitative synthesis is criticalSummary evidence tables

Undigestible Catalog of Results

Synthesize the EvidenceAvoid merely listing results of individual

studies… “Smith found no effect, while Jones and

colleagues found a significant effect…”

Acknowledge quality of underlying evidence…

“Smith found no effect in a small, open, non-randomized trial. However, Jones and colleagues found a significant effect compared to placebo in a large, placebo-controlled trial…”

Summary of Evidence.

Nelson H D et al. Ann Intern Med 2009;151:727-737

©2009 by American College of Physicians

Major thromboembolic events in PST or PSM versus usual care studies.PSM = patient self-management; PST = patient self-testing.

Bloomfield H E et al. Ann Intern Med 2011;154:472-482

©2011 by American College of Physicians

Risk for bias.ITT = intention-to-treat.

Bloomfield H E et al. Ann Intern Med 2011;154:472-482

©2011 by American College of Physicians

Routinely address in methods and results

Acknowledge in discussion how heterogeneity influences conclusions

Inadequate handling of heterogeneity

Search trials registriesMention ongoing trials and

anticipated availability in discussion

Need more routine description of updating process, expiration dates

Impending Evidence

Optimizing Review Reporting

Clear question(s)Provide detail but be conciseJudicious use of tables, figures,

technical appendicesSummary evidence tablesQualitative synthesesDiscuss anticipated new evidence