To the Editor: Most textbooks and guidance documents on systematic reviews discuss the caveats and potential risks of heterogeneity in meta-analysis. It is not appreciated that extreme homogeneity in a meta-analysis can be a far stronger signal of major problems.1 The careful meta-analysis of hydroxyethyl starch for fluid resuscitation by Dr Zarychanski and colleagues2 exemplifies this issue.
Ioannidis JPA. Meta-analyses of Hydroxyethyl Starch for Volume Resuscitation. JAMA. 2013;309(21):2209. doi:10.1001/jama.2013.5817
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