ArticleJournal of clinical epidemiology2020
Fragility index of network meta-analysis with application to smoking cessation data.
Article in Journal of clinical epidemiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Meta-analyses in paediatric surgery are often fragile: implications and consequences.Pediatric surgery international · 2021Pooled it
- An alternative method for assessing the fragility of survival analysis results: a proof-of-concept study based on the log-rank test.American journal of epidemiology · 2026Article
- Tipping point analysis for the between-arm correlation in an arm-based evidence synthesis.BMC medical research methodology · 2024Article
- Measuring the impact of zero-cases studies in evidence synthesis practice using the harms index and benefits index (Hi-Bi).BMC medical research methodology · 2023Article
- Assessing the robustness of results from clinical trials and meta-analyses with the fragility index.American journal of obstetrics and gynecology · 2023Review
- Empirical assessment of fragility index based on a large database of clinical studies in the Cochrane Library.Journal of evaluation in clinical practice · 2023Article
- Paediatric surgical trials, their fragility index, and why to avoid using it to evaluate results.Pediatric surgery international · 2022Article
- Assessing and visualizing fragility of clinical results with binary outcomes in R using the fragility package.PloS one · 2022Article
- Fragility indices for only sufficiently likely modifications.Proceedings of the National Academy of Sciences of the United States of America · 2021Article
- The fragility index may not be ideal for paediatric surgical conditions: the example of foetal endoscopic tracheal occlusion.Pediatric surgery international · 2021Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
BACKGROUND AND
objectivesThe network meta-analysis (NMA) is frequently used to synthesize evidence for multiple treatment comparisons, but its complexity may affect the robustness (or fragility) of the results. The fragility index (FI) is recently proposed to assess the fragility of the results from clinical studies and from pairwise meta-analyses. We extend the FI to NMAs with binary outcomes.
methodsWe define the FI for each treatment comparison in NMAs. It quantifies the minimal number of events necessary to be modified for altering the comparison's statistical significance. We introduce an algorithm to derive the FI and visualizations of the process. A worked example of smoking cessation data is used to illustrate the proposed methods.
resultsSome treatment comparisons had small FIs; their significance (or nonsignificance) could be altered by modifying a few events' status. They were related to various factors, such as P-values, event counts, and sample sizes, in the original NMA. After modifying event status, treatment ranking measures were also changed to different extents.
conclusionMany NMAs include insufficiently compared treatments, small event counts, or small sample sizes; their results are potentially fragile. The FI offers a useful tool to evaluate treatment comparisons' robustness and reliability.
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