Como avaliar criticamente revisões sistemáticas e metanálises?

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Abstract

JUSTIFICATIVA E OBJETIVOS: Revisões sistemáticas são ferramentas importantes no fornecimento de evidências para tomada de decisão na prática da Terapia Intensiva. O objetivo deste estudo foi descrever os elementos importantes na avaliação crítica das revisões sistemáticas existentes em Terapia Intensiva. CONTEÚDO: Na avaliação crítica da revisão sistemática, é necessário que o intensivista atente para a estruturação da questão a ser respondida, a estratégia de busca utilizada, os critérios de inclusão e a qualidade metodológica dos estudos incluídos, e como foram extraídos os dados levantados. Além disso, uma revisão sistemática relevante deve apresentar resultados consistentes (caso tenha sido realizada metanálise) ou a causa de heterogeneidade deve ter sido explorada, e os resultados devem ser aplicáveis no paciente crítico. CONCLUSÕES: Para o correto emprego da evidência científica disponível, é necessário que o intensivista avalie criticamente a qualidade dos dados apresentados nas revisões sistemáticas, selecionando as informações relevantes para o manuseio do paciente crítico.

Translated abstract

BACKGROUND AND OBJECTIVES: Systematic reviews are important knowledge generating tools to help the decision making process in the Critical Care Unit. This narrative aims to describe the important elements used to critically appraise intensive care-related systematic reviews. CONTENTS: When critically assessing systematic reviews, one should pay particular attention to the importance and appropriateness of the research question, the search strategy, the inclusion criteria and methodological quality of the studies included, and the methods of data extraction. In addition, a relevant systematic review must have consistent data (in case of a meta-analysis) or the cause of the heterogeneity must have been adequately explored, and results must be applicable in critical patients. CONCLUSIONS: To apply correctly the available scientific evidence, one should critically assess data quality of systematic reviews, selecting the relevant information to manage the critically ill patient.

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Most cited references 41

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The medical review article: state of the science.

C D Mulrow (1987)

Fifty reviews published during June 1985 to June 1986 in four major medical journals were assessed in a study of the methods of current review articles. Assessments were based on eight explicit criteria adapted from published guidelines for information syntheses. Of the 50 articles, 17 satisfied three of the eight criteria; 32 satisfied four or five criteria; and 1 satisfied six criteria. Most reviews had clearly specified purposes (n = 40) and conclusions (n = 37). Only one had clearly specified methods of identifying, selecting, and validating included information. Qualitative synthesis was often used to integrate information included in the review (n = 43); quantitative synthesis was rarely used (n = 3). Future research directives were mentioned in 21. These results indicate that current medical reviews do not routinely use scientific methods to identify, assess, and synthesize information. The methods used in this systematic assessment of reviews are proposed to improve the quality of future review articles.