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Users' Guides to the Medical Literature
July 9, 2014

How to Read a Systematic Review and Meta-analysis and Apply the Results to Patient CareUsers’ Guides to the Medical Literature

Author Affiliations
  • 1Division of Preventive Medicine and Knowledge and Evaluation Research Unit, Mayo Clinic, Minnesota
  • 2Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
  • 3Departments of Medicine and Health Research and Policy, Stanford University School of Medicine; Department of Statistics, Stanford University School of Humanities and Sciences; and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California
  • 4Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
  • 5Departments of Medicine and Clinical Epidemiology and Biostatistics and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
  • 6All India Institute of Medical Sciences, New Delhi
  • 7Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
  • 8Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Santiago, Chile, and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
  • 9Department Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
  • 10Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  • 11Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
  • 12Columbia University Medical Center, New York, New York
  • 13Departments of Medicine and Clinical Epidemiology and Biostatistics and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
  • 14Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
JAMA. 2014;312(2):171-179. doi:10.1001/jama.2014.5559
Abstract

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 of magnitude of beneficial and harmful effects, and confidence in those estimates.

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