Users' guide to detecting misleading claims in research
http://www.100md.com
《英国医生杂志》
EDITOR—Montori et al cite the Cochrane albumin review in the table comparing two systematic reviews of albumin for fluid resuscitation.1 2 This review is an egregious example of a review that made a misleading claim—in this case a 6% additional mortality when albumin was compared with saline in a meta-analysis.
The users' guide of Montori et al is designed for assessing a single randomised controlled trial; when many randomised controlled trials are amalgamated into a review, the compilers demand a degree of trust from those who use their review for guidance. In dealing with a complex diverse subject, such as critical illness, no ordinary reader, editor, or peer reviewer, will examine critically all the randomised controlled trials from which the review's authors derived their conclusions.
In the Cochrane albumin review, seven randomised controlled trials were adduced to support the mistaken contention that albumin, used in the treatment of hypovolaemia, would result in one additional death for every 17 patients compared with saline. I made criticisms of each of these randomised controlled trials, and the authors of the review did not answer any of them.3
Reviews such as this are usually assessed by the Centre for Research and Development, whose aim is to raise the general standard of reviews in the NHS. Its comment on this review was that Cochrane reviews are of a high standard and are not evaluated by one of its reviewers.4 It has taken six years for the SAFE study to disprove the erroneous allegation of the albumin review,5 and so far there has been no retraction by any member of the Cochrane Collaboration.
Peter J Horsey, honorary consultant anaesthetist
Ashley, Stockbridge, Hampshire SO20 6RH Horsey@lineone.net
Competing interests: None declared.
References
Montori VM, Jaeschke R, Schünemann HJ, Bhandari M, Brozek JA, Deveraux PJ, et al. User's guide to detecting misleading claims in clinical research reports. BMJ 2004;329: 1093-6. (6 November.)
Cochrane Injuries Group Albumin Reviewers. Human albumin administration in critically ill patients: systematic review of randomised controlled trials. BMJ 1998;317: 235-40.
Horsey P; Roberts I. Albumin and hypovolaemia. Lancet 2002;359: 70-3.
NHS Centre for Reviews and Dissemination. Human albumin administration in critically ill patients: systematic reviews of randomised trials. Database of Abstracts of Reviews (DARE) document 124582, accessed 22 June 2002.
Saline versus albumin study evaluation. A comparison of saline and albumin for fluid resuscitation in the intensive care unit. The SAFE Study Investigators. N Engl J Med 2004;350: 2247-56.
The users' guide of Montori et al is designed for assessing a single randomised controlled trial; when many randomised controlled trials are amalgamated into a review, the compilers demand a degree of trust from those who use their review for guidance. In dealing with a complex diverse subject, such as critical illness, no ordinary reader, editor, or peer reviewer, will examine critically all the randomised controlled trials from which the review's authors derived their conclusions.
In the Cochrane albumin review, seven randomised controlled trials were adduced to support the mistaken contention that albumin, used in the treatment of hypovolaemia, would result in one additional death for every 17 patients compared with saline. I made criticisms of each of these randomised controlled trials, and the authors of the review did not answer any of them.3
Reviews such as this are usually assessed by the Centre for Research and Development, whose aim is to raise the general standard of reviews in the NHS. Its comment on this review was that Cochrane reviews are of a high standard and are not evaluated by one of its reviewers.4 It has taken six years for the SAFE study to disprove the erroneous allegation of the albumin review,5 and so far there has been no retraction by any member of the Cochrane Collaboration.
Peter J Horsey, honorary consultant anaesthetist
Ashley, Stockbridge, Hampshire SO20 6RH Horsey@lineone.net
Competing interests: None declared.
References
Montori VM, Jaeschke R, Schünemann HJ, Bhandari M, Brozek JA, Deveraux PJ, et al. User's guide to detecting misleading claims in clinical research reports. BMJ 2004;329: 1093-6. (6 November.)
Cochrane Injuries Group Albumin Reviewers. Human albumin administration in critically ill patients: systematic review of randomised controlled trials. BMJ 1998;317: 235-40.
Horsey P; Roberts I. Albumin and hypovolaemia. Lancet 2002;359: 70-3.
NHS Centre for Reviews and Dissemination. Human albumin administration in critically ill patients: systematic reviews of randomised trials. Database of Abstracts of Reviews (DARE) document 124582, accessed 22 June 2002.
Saline versus albumin study evaluation. A comparison of saline and albumin for fluid resuscitation in the intensive care unit. The SAFE Study Investigators. N Engl J Med 2004;350: 2247-56.