How to Use an Article Reporting a Multiple Treatment Comparison Meta-analysis

Mills, Edward J.; Ioannidis, John P. A.; Thorlund, Kristian; Schünemann, Holger J.; Puhan, Milo A.; Guyatt, Gordon

doi:10.1001/2012.jama.11228

Cited by 338 publications

(196 citation statements)

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“…Network meta-analyses, also called multiple-treatment comparison meta-analyses, provide an approach to simultaneous consideration of the relative effectiveness of multiple treatment alternatives [17,23,29]. The benefit of a network meta-analysis includes the potential for providing indirect evidence, which refers to the determination of relative treatment effects between two treatments when head-to-head trials (ie, direct evidence) are not available [29].…”

Section: Introductionmentioning

confidence: 99%

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Which Surgical Treatment for Open Tibial Shaft Fractures Results in the Fewest Reoperations? A Network Meta-analysis

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Guyatt

Vignesh

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Open tibial shaft fractures are one of the most devastating orthopaedic injuries. Surgical treatment options include reamed or unreamed nailing, plating, Ender nails, Ilizarov fixation, and external fixation. Using a network meta-analysis allows comparison and facilitates pooling of a diverse population of randomized trials across these approaches in ways that a traditional meta-analysis does not. Questions/purposes Our aim was to perform a network meta-analysis using evidence from randomized trials on the relative effect of alternative approaches on the risk of unplanned reoperation after open fractures of the tibial diaphysis. Our secondary study endpoints included malunion, deep infection, and superficial infection. Methods A network meta-analysis allows for simultaneous consideration of the relative effectiveness of multiple treatment alternatives. To do this on the subject of surgical treatments for open tibial fractures, we began with systematic searches of databases (including EMBASE and MEDLINE) and performed hand searches of orthopaedic journals, bibliographies, abstracts from orthopaedic conferences, and orthopaedic textbooks, for all relevant material published between 1980 and 2013. Two authors independently screened abstracts and manuscripts and extracted the data, three evaluated the risk of bias in individual studies, and two applied Grading of Recommendation Assessment, Development and Evaluation (GRADE) criteria to bodies of evidence. We included all randomized and quasirandomized trials comparing two (or more) surgical treatment options for open tibial shaft fractures in predominantly (ie, [ 80%) adult patients. We calculated pooled estimates for all direct comparisons and conducted a network meta-analysis combining direct and indirect evidence for all 15 comparisons between six stabilization strategies. Fourteen trials published between Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. This study was performed at

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Section: Introductionmentioning

confidence: 99%

“…The benefit of a network meta-analysis includes the potential for providing indirect evidence, which refers to the determination of relative treatment effects between two treatments when head-to-head trials (ie, direct evidence) are not available [29].…”

Section: Introductionmentioning

confidence: 99%

Which Surgical Treatment for Open Tibial Shaft Fractures Results in the Fewest Reoperations? A Network Meta-analysis

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Guyatt

Vignesh

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…In general, certainty in effect sizes and directions varies widely among comparisons in a network [20,21]. A NMA therefore can provide results warranting moderate or high certainty for some comparisons and low or very low certainty for others.…”

Section: Introductionmentioning

confidence: 99%

Network Meta-analysis: Users’ Guide for Surgeons: Part II - Certainty

Chaudhry

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Guyatt

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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In the previous article (Network Meta-analysis: Users' Guide for Surgeons-Part I, Credibility), we presented an approach to evaluating the credibility or methodologic rigor of network meta-analyses (NMA), an innovative approach to simultaneously addressing the relative effectiveness of three or more treatment options for a given medical condition or disease state. In the second part of the Users' Guide for Surgeons, we discuss and demonstrate the application of criteria for determining the certainty in effect sizes and directions associated with a given treatment option through an example pertinent to clinical orthopaedics.

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“…Even so, this probability needs to be interpreted with caution, as one may wish to know the probability that a treatment is better than another treatment by a clinically important margin rather than whether or not a treatment is the ''best option''. 6,7 If multiple treatment comparison analysis follows in the footsteps of its cousin meta-analysis, the studies by Maund et al 2 and Rashiq et al 1 will be only the first two of many to appear in the anesthesia literature.…”

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confidence: 99%

“…En effet, on pourrait souhaiter savoir que la probabilité qu'un traitement soit meilleur qu'un autre se fonde sur une marge importante d'un point de vue clinique, plutôt que sur le fait de savoir si un traitement est, ou non, la « meilleure option ». 6,7 Si l'analyse de comparaison de plusieurs traitements suit les pas de sa cousine la méta-analyse, les études de Maund et coll.…”

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Multiple treatment comparison analysis: If A is better than B, and B is better than C, is A better than C?

Brasher

2013

Can J Anesth/J Can Anesth

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How to Use an Article Reporting a Multiple Treatment Comparison Meta-analysis

Cited by 338 publications

References 50 publications

Which Surgical Treatment for Open Tibial Shaft Fractures Results in the Fewest Reoperations? A Network Meta-analysis

Which Surgical Treatment for Open Tibial Shaft Fractures Results in the Fewest Reoperations? A Network Meta-analysis

Network Meta-analysis: Users’ Guide for Surgeons: Part II - Certainty

Multiple treatment comparison analysis: If A is better than B, and B is better than C, is A better than C?

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