Meta-analyses are increasingly popular for synthesizing multiple trials to determine the "true" effect of a particular therapy. We use the term meta-analysis to refer to a systematic review that applies quantitative methods to combine data from multiple trials. In this issue of the ARCHIVES, Hartling et al1 use this method to examine the efficacy of epinephrine hydrochloride in the treatment of bronchiolitis.
Despite their recent proliferation, meta-analyses are difficult to appraise in a critical fashion. In this article, we have used several resources2-5 with minor modifications as a guide to evaluating the meta-analysis by Hartling and colleagues.
CHOOSING THE QUESTION
Is the Question Important?
Yes. Viral bronchiolitis is a common yet potentially serious illness in young children. Although it places a significant burden on the health care system, no single treatment has proved most effective. A meta-analysis showing that epinephrine is efficacious in the treatment of bronchiolitis would be an important contribution to the literature and could . . . [Full Text of this Article]
Is the Question Clearly Defined?
CHOOSING AND APPRAISING STUDIES
Are the Inclusion Criteria Appropriate?
Is It Likely That Relevant Studies Were Missed?
Was the Quality of Studies Adequately Appraised and Accounted For?
COMBINING THE DATA
Were Decisions Regarding Whether to Combine Data, and What Data to Combine, Made Appropriately?
Did the Authors Estimate a Single Common Effect?
Was Heterogeneity Among Studies Adequately Accounted For?
Were Estimates of Common Effects Robust?
Were the Results Presented Appropriately?
APPLYING THE RESULTS TO CLINICAL PRACTICE
Were All Clinically Important Outcomes Considered?
Are the Benefits Worth the Harms and Costs?
Can the Results Be Applied to My Patient Care?
