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THE INFLUENCE OF METHODOLOGIC QUALITY ON THE CONCLUSION OF A LANDMARK META-ANALYSIS ON THROMBOLYTIC THERAPY

Published online by Cambridge University Press:  20 May 2002

Arianne P. Verhagen ,
Henrica C. W. de Vet ,
Frank Vermeer ,
Jos W. M. G. Widdershoven ,
Robert A. de Bie ,
Alphons G. H. Kessels ,
Maarten Boers  and
Piet A. van den Brandt
Arianne P. Verhagen
Affiliation:
Maastricht University and Erasmus University Rotterdam
Henrica C. W. de Vet
Affiliation:
Maastricht University and Vrije Universiteit
Frank Vermeer
Affiliation:
Maastricht University Hospital
Jos W. M. G. Widdershoven
Affiliation:
Twee Steden Hospital
Robert A. de Bie
Affiliation:
Maastricht University
Alphons G. H. Kessels
Affiliation:
Maastricht University and Maastricht University Hospital
Maarten Boers
Affiliation:
Vrije Universiteit
Piet A. van den Brandt
Affiliation:
Maastricht University
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Abstract

Objective: We studied the influence of the methodologic quality of individual trials on the outcome of a landmark meta-analysis on thrombolytic therapy in acute myocardial infarction. From each study we extracted the number of patients in both groups who died in hospital or during follow-up. Methodologic quality was assessed using the Delphi list. We first recalculated pooled odds ratios (ORs) and 95% confidence intervals (CIs), on the studies found and compared them with the original results of Yusuf et al. Next we incorporated the results of quality assessment in five different ways in the calculation of the pooled ORs: a) component analysis; b) visual plot; c) quality score as a threshold score; d) quality score as a weighting factor; and e) cumulative pooling.

Results and Conclusion: No correlation between quality scores and ORs was found. Studies with a proper description of the different quality components provided an estimate close to the true treatment effect. No major differences were found between the results of the five different methods of incorporating the quality scores into the final conclusion.

Keywords

Quality assessmentRandomized clinical trialsOutcome assessmentThrombolytic therapyEmpiricalMethodology
Type
Research Article
Information
International Journal of Technology Assessment in Health Care , Volume 18 , Issue 1 , January 2002 , pp. 11 - 23
Copyright
© 2002 Cambridge University Press

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