Evidence map›Paper›PMID 28880258›Full record

ArticleJournal of perinatology : official journal of the California Perinatal Association2017

Do trials reduce uncertainty? Assessing impact through cumulative meta-analysis of neonatal RCTs.

S C Hay, H Kirpalani, C Viner, R Soll, D Dukhovny, W-Y Mao, J Profit, S B DeMauro, J A F Zupancic

Abstract read
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In one paragraph

Article in Journal of perinatology : official journal of the California Perinatal Association, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Early progressive feeding in extremely preterm infants: a randomized trial.The American journal of clinical nutrition · 2018
    Trial
  2. Systematic reviews and meta-analysis: why might more clinical trials yield no greater precision?Journal of perinatology : official journal of the California Perinatal Association · 2017
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

S C HayDepartment of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
H KirpalaniDivision of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
C VinerDepartment of Obstetrics and Gynecology, New York University, New York, NY, USA.
R SollDivision of Neonatal Perinatal Medicine, University of Vermont College of Medicine, Burlington, VT, USA.
D DukhovnyDivision of Neonatology, Oregon Health and Science University, Portland, OR, USA.
W-Y MaoDepartment of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
J ProfitDivision of Neonatology, Stanford University, Stanford, CA, USA.
S B DeMauroDivision of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J A F ZupancicDepartment of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess the impact of the latest randomized controlled trial (RCT) to each systematic review (SR) in Cochrane Neonatal Reviews. STUDY

designWe selected meta-analyses reporting the typical point estimate of the risk ratio for the primary outcome of the latest study (n=130), mortality (n=128) and the mean difference for the primary outcome (n=44). We employed cumulative meta-analysis to determine the typical estimate after each trial was added, and then performed multivariable logistic regression to determine factors predictive of study impact.

resultsFor the stated primary outcome, 18% of latest RCTs failed to narrow the confidence interval (CI), and 55% failed to decrease the CI by ⩾20%. Only 8% changed the typical estimate directionality, and 11% caused a change to or from significance. Latest RCTs did not change the typical estimate in 18% of cases, and only 41% changed the typical estimate by at least 10%. The ability to narrow the CI by >20% was negatively associated with the number of previously published RCTs (odds ratio 0.707). Similar results were found in analysis of typical estimates for the outcomes of mortality and mean difference.

conclusionAcross a broad range of clinical questions, the latest RCT failed to substantially narrow the CI of the typical estimate, to move the effect estimate or to change its statistical significance in a majority of cases. Investigators and grant peer review committees should consider prioritizing less-studied topics or requiring formal consideration of optimal information size based on extant evidence in power calculations.

Indexed as

Meta-Analysis as TopicNeonatologyRandomized Controlled Trials as TopicUncertaintyConfidence IntervalsHumansLogistic ModelsOutcome Assessment, Health CareReview Literature as Topic

Identifiers

PMID28880258

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.