Comment lire des revues systématiques et des méta-analyses : nouveau guide de lecture

JAMA logoDans la série des Users' guides to the medical literature du JAMA, un nouvel article (9 juillet 2014) qui vient justement remplacer l'ancien guide de 1994 sur l'utilisation des "overview articles". Tout a changé en moins de 20 ans, et ce guide explique comment mettre en pratique ces revues systématiques et méta-analyses, avec un scénario clinique comme exemple..  plutôt bien. Mais pour évaluer la qualité des revues systématiques, la grille AMSTAR est aussi excellente, voire complémentaire. Dans l'article du JAMA, deux encadrés sont bien faits, et je les reproduis ci-dessous :

Box 1. The Process of Conducting a Systematic Review and Meta-analysis
1. Formulate the question
2. Define the eligibility criteria for studies to be included in terms
of Patient, Intervention, Comparison, Outcome (PICO), and
study design
3. Develop a priori hypotheses to explain heterogeneity
4. Conduct search
5. Screen titles and abstracts for inclusion
6. Review full text of possibly eligible studies
7. Assess the risk of bias
8. Abstract data
9. When meta-analysis is performed:
• Generate summary estimates and confidence intervals
• Look for explanations of heterogeneity
• Rate confidence in estimates of effect

Box 2. Guide for Appraising and Applying the Results of a Systematic Review and Meta-analysis*
First Judgment: Evaluate the Credibility of the Methods of Systematic Review
Did the review explicitly address a sensible clinical question?
Was the search for relevant studies exhaustive?
Were selection and assessments of studies reproducible?
Did the review present results that are ready for clinical application?
Did the review address confidence in estimates of effect?
Second Judgment: Rate the Confidence in the Effect Estimates
How serious is the risk of bias in the body of evidence?
Are the results consistent across studies?
How precise are the results?
Do the results directly apply to my patient?
Is there concern about reporting bias?
Are there reasons to increase the confidence rating?
* Systematic reviews can address multiple questions. This guide is applied to aspects of the systematic review that answer the clinical question at hand—ideally the effect of the intervention vs the comparator of interest on all outcomes of importance to patients.

Murad MH, et al. How to read a systematic review and meta-analysis and apply the results to patient care. Users's guide to the medical literature. JAMA 2014;312(2):171-179.

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