SynthesisPediatric surgery international2021
Meta-analyses in paediatric surgery are often fragile: implications and consequences.
Synthesis in Pediatric surgery international, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 4 of them syntheses that pooled it.
What it found
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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.
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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.
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Who cites it
15 citing papers in PubMed, 4 syntheses or guidelines pooled it, 17 citations in OpenAlex.
- Exploring the fragility of meta-analyses in ophthalmology: a systematic review.Eye (London, England) · 2024Pooled it
- Assessing the robustness of COVID-19 vaccine efficacy trials: systematic review and meta-analysis, January 2023.Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2023Pooled it
- Predictors of Increased Fragility Index Scores in Surgical Randomized Controlled Trials: An Umbrella Review.World journal of surgery · 2023Pooled it
- Meta-analyses in paediatric surgery are often fragile: implications and consequences.Pediatric surgery international · 2021Pooled it
- Determining the Conclusiveness of Systematic Review Evidence : A Scoping Review of Methodological Approaches.Annals of internal medicine · 2026Article
- Assessing the robustness of vascular surgery meta-analyses using the Fragility Index: a cross-sectional study.BMJ open · 2025Article
- How trustworthy and applicable is the evidence from systematic reviews of depression treatments: Protocol for systematic examination.PloS one · 2025Article
- Fragility of statistically significant outcomes in randomized trials comparing bariatric surgeries.International journal of obesity (2005) · 2023Review
- Fragility of statistically significant findings from randomized trials in comparing laparoscopic versus robotic abdominopelvic surgeries.Surgical endoscopy · 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
- Robustness of meta-analysis results in Cochrane systematic reviews: A case for acupuncture trials.Integrative medicine research · 2022Article
- Paediatric surgical trials, their fragility index, and why to avoid using it to evaluate results.Pediatric surgery international · 2022Article
- The fragility index may not be ideal for paediatric surgical conditions: the example of foetal endoscopic tracheal occlusion.Pediatric surgery international · 2021Article
- Fragility Index of Recently Published Meta-Analyses in Pediatric Urology: A Striking Observation.Cureus · 2021Article
- Fragility index of meta-analyses in paediatric surgery.Pediatric surgery international · 2021Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeMeta-analyses occupy the highest level of evidence and thereby guide clinical decision-making. Recently, randomised-controlled trials were evaluated for the robustness of their findings by calculating the fragility index. The fragility index is the number of events that needs to be added to one treatment arm until the statistical significance collapses. We, therefore, aimed to evaluate the robustness of paediatric surgical meta-analyses.
methodsWe searched MEDLINE for paediatric surgical meta-analyses in the last decade. All meta-analyses on a paediatric surgical condition were eligible for analysis if they based their conclusion on a statistically significant meta-analysis.
resultsWe screened 303 records and conducted a full-text evaluation of 60 manuscripts. Of them, 39 were included in our analysis that conducted 79 individual meta-analyses with significant results. Median fragility index was 5 (Q25-Q75% 2-11). Median fragility in relation to included patients was 0.77% (Q25-Q75% 0.29-1.87%).
conclusionPaediatric surgical meta-analyses are often fragile. In almost 60% of results, the statistical significance depends on less than 1% of the included population. However, as the fragility index is just a transformation of the P value, it basically conveys the same information in a different format. It therefore should be avoided.
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Registered trials
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.