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Letters
March 15, 2000

Scoring the Quality of Clinical Trials—Reply

Author Affiliations
 

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(11):1421-1423. doi:10.1001/jama.283.11.1421

In Reply: In our study, we repeated Nurmohamed and colleagues'1 meta-analysis of 17 trials of LMWH for prevention of deep vein thrombosis, using 25 scales to identify high-quality trials. We included all widely used scales but none produced summary scores that were significantly associated with treatment effects. Dr ter Riet and colleagues argue that our results could be explained by the inclusion of scales that were developed for specific contexts. Dr Assendelft and colleagues imply that our findings would have been different if we had used updated versions of scales. They argue that we should have used the 1997 version of their scale,2 which gives more weight to the internal validity of trials, rather than the version published in 1991.3 The revised scale is recommended by the Cochrane Back Review Group,2 but only 2 of the 8 reviews published by this group in the Cochrane Library have actually used this scale. This observation, and the large number of published scales, underscore the uncertainty that exists in this area.

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