Artículo de revista
How to read a systematic review andmeta-analysis and apply the results to patient care users’ guides to the medical literature
Fecha
2014Registro en:
JAMA. 2014;312(2):171-179
DOI: 10.1001/jama.2014.5559
Autor
Hassan Murad, Mohammad
Montori, Víctor M.
Ioannidis, John P. A.
Jaeschke, Román
Devereaux, P. J.
Prasad, Kameshwar
Neumann, Ignacio
Carrasco Labra, Raúl
Agoritsas, Thomas
Hatala, Rose
Meade, Maureen O.
Wyer, Peter
Cook, Deborah J.
Guyatt, Gordon H.
Institución
Resumen
Clinical decisions should be based on the totality of the best evidence and not the results of
individual studies. When clinicians apply the results of a systematic review or meta-analysis to
patient care, they should start by evaluating the credibility of the methods of the systematic
review, ie, the extent to which these methods have likely protected against misleading
results. Credibility depends on whether the review addressed a sensible clinical question;
included an exhaustive literature search; demonstrated reproducibility of the selection and
assessment of studies; and presented results in a useful manner. For reviews that are
sufficiently credible, clinicians must decide on the degree of confidence in the estimates that
the evidence warrants (quality of evidence). Confidence depends on the risk of bias in the
body of evidence; the precision and consistency of the results; whether the results directly
apply to the patient of interest; and the likelihood of reporting bias. Shared decision making
requires understanding of the estimates ofmagnitude of beneficial and harmful effects, and
confidence in those estimates.