Restrictive or responsive? Outcome classification and unplanned sub‐group analyses in meta‐analyses

Klimek, Markus; Hoeks, Sanne E.

doi:10.1111/anae.14078

Cited by 7 publications

(7 citation statements)

References 19 publications

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“…However, this is an emerging epidemiological method, and caution should be applied in interpreting the results produced. In any network meta‐analysis, assumptions of transitivity, congruence and consistency are made . In this meta‐analysis, our assumption of transitivity is valid, as each delivery regimen could suitably be considered for similar indications.…”

Section: Discussionmentioning

confidence: 99%

Local anaesthetic delivery regimens for peripheral nerve catheters: a systematic review and network meta‐analysis

et al. 2019

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There are numerous possible techniques for delivering local anaesthetic through peripheral nerve catheters. These include continuous infusions, patient-controlled boluses and programmed intermittent boluses. The optimal delivery regimen of local anaesthetic is yet to be conclusively established. In this review, we identified prospective trials of delivery regimens through peripheral nerve catheters. Our primary outcome was visual analogue scale scores for pain at 48 h. Secondary outcomes were: visual analogue scores at 24 h; patient satisfaction scores; rescue opioid use; local anaesthetic consumption; and nausea and vomiting. Network metaanalysis was used to compare these outcomes. Predefined sub-group analyses were performed. Thirty-three studies enrolling 1934 participants were included. In comparison with continuous infusion, programmed intermittent boluses improved visual analogue pain scores at both 48 and 24 h, the weighted mean difference (95%CI) being À0.63 (À1.12 to À0.14), p = 0.012 and À0.48 (À0.92 to À0.03), p = 0.034, respectively. Programmed intermittent boluses also improved satisfaction scores, the weighted mean difference (95%CI) being 0.70 (0.10-1.31), p = 0.023, and reduced rescue opioid use, the weighted mean difference (95%CI) in oral morphine equivalent at 24 h being À23.84 mg (À43.90 mg to À3.77 mg), p = 0.020. Sub-group analysis revealed that these findings were mostly confined to lower limb and truncal catheter studies; there were few studies of programmed intermittent boluses for upper limb catheters. Programmed intermittent boluses may provide optimal delivery of a local anaesthetic through peripheral nerve catheters. Further research is warranted, particularly to delineate the differences between upper and lower limb catheter locations, which will help clarify the clinical relevance of these findings.

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Section: Discussionmentioning

confidence: 99%

Local anaesthetic delivery regimens for peripheral nerve catheters: a systematic review and network meta‐analysis

et al. 2019

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“…Also, for systematic reviews it may not be necessary to specify whether or not these are primary or secondary outcomes. Instead, all outcomes should undergo the same testing and be adjusted for their level of significance . Measurement instruments for these outcomes are next considered based on the psychometric body of evidence.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of outcomes in postoperative pain studies in paediatric and adolescent patients: towards development of a core outcome set

et al. 2018

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Systematic reviews of postoperative pain in children have called into question the consistency of outcomes measured by clinical triallists as well as the measurement instruments used for assessment. Core outcome set methodology may be a solution to improve standardisation. This study provides an evidence-based foundation for the development of a core outcome set for paediatric postoperative pain studies. We searched ClinicalTrials.gov to identify relevant postoperative pain studies in children. The search yielded 300 registered trials. The following data were then extracted from each of the trials: phase of trial; study type; study design; sample size; all outcomes; whether the outcome was listed as primary, secondary, or tertiary; the measurement instrument for each reported outcome; the specific metric for each outcome; and the type of clinical procedure. Following screening, 134 studies were included in our study. Pain measurement was the most commonly reported outcome (n = 123), followed by total postoperative analgesic dosage (n = 83) and side-effects (n = 25). Temporal trends indicated that pain assessment and unexpected events increased in use between 2000 and 2016, whereas postoperative analgesia measurement decreased. We found a lack of standardisation among outcomes and measurement instruments in paediatric postoperative pain studies. Development of a core outcome set may improve the quality of future trials and allow for more accurate study-to-study comparisons.

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“…They are often based on a particular outcome that may not be of interest to all stakeholders. Others have argued along similar lines, commenting that TSA is likely to be performed on the primary outcome only, meaning that the risk of spurious findings will still persist for reported secondary outcomes [26]. The Panel also argued that although similarities have been drawn between TSA and the conduct of a clinical trial, especially with regard to futility boundaries which assist data monitoring committees, meta-analyses are retrospective and observational by nature.…”

Section: Limitations Of Trial Sequential Analysismentioning

confidence: 99%

“…Even within the Cochrane Collaboration, with its standardised methods, reviews on topics of clinical relevance to anaesthetists have not routinely applied TSA in the past, with some choosing to [21,22] and other not [23,24]. In fact, commenting that TSA is likely to be performed on the primary outcome only, meaning that the risk of spurious findings will still persist for reported secondary outcomes [26]. The Panel also argued that although similarities have The graph now shows that the required information size using these assumptions would be 1289, which is almost double than the number already accrued so far.…”

Section: Limitations Of Trial Sequential Analysismentioning

confidence: 99%

Trial sequential analysis: adding a new dimension to meta‐analysis

Shah

Smith

2019

Anaesthesia

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Restrictive or responsive? Outcome classification and unplanned sub‐group analyses in meta‐analyses

Cited by 7 publications

References 19 publications

Local anaesthetic delivery regimens for peripheral nerve catheters: a systematic review and network meta‐analysis

Local anaesthetic delivery regimens for peripheral nerve catheters: a systematic review and network meta‐analysis

A systematic review of outcomes in postoperative pain studies in paediatric and adolescent patients: towards development of a core outcome set

Trial sequential analysis: adding a new dimension to meta‐analysis

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