ArticleBMC medicine2021
Utilization of the evidence from studies with no events in meta-analyses of adverse events: an empirical investigation.
Article in BMC medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 4 of them syntheses that pooled 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.
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.
Who cites it
21 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Pooled it
- Association of bevacizumab and stroke in ovarian cancer: a systematic review and meta-analysis.Frontiers in neuroscience · 2023Pooled it
- Immune-related adverse events associated with nab-paclitaxel/paclitaxel combined with immune checkpoint inhibitors: a systematic review and network meta-analysis.Frontiers in immunology · 2023Pooled it
- Comparison of out-of-plane short axis with in-plane long axis for ultrasound-guided radial arterial cannulation: A systematic review with trial sequential analysis of randomised controlled trials.Frontiers in cardiovascular medicine · 2022Pooled it
- Random-effects meta-analysis models for pooling rare events data: a comparison between frequentist and bayesian methods.BMC medical research methodology · 2025Article
- ZIBGLMM: Zero-inflated bivariate generalized linear mixed model for meta-analysis with double-zero-event studies.Research synthesis methods · 2025Article
- Comparative Genomic Analysis of Livestock-DerivedJournal of microbiology and biotechnology · 2025Article
- The Role of Double-Zero-Event Studies in Evidence Synthesis: Evaluating Robustness Using the Fragility Index.Journal of evaluation in clinical practice · 2025Article
- Assessment of inverse publication bias in safety outcomes: an empirical analysis.BMC medicine · 2024Article
- Harm effects in non-registered versus registered randomized controlled trials of medications: a retrospective cohort study of clinical trials.BMC medicine · 2024Article
- Advanced therapy with mesenchymal stromal cells for knee osteoarthritis: Systematic review and meta-analysis of randomized controlled trials.Journal of orthopaedic translation · 2024Review
- Accelerating evidence synthesis for safety assessment through ClinicalTrials.gov platform: a feasibility study.BMC medical research methodology · 2024Article
- Influence of lack of blinding on the estimation of medication-related harms: a retrospective cohort study of randomized controlled trials.BMC medicine · 2024Article
- A Commentary on "Cervical Rotation-Traction Manipulation for Cervical Radiculopathy: A Systematic Review and Meta-Analysis of Randomized Control Trials" [Letter].Journal of pain research · 2024Article
- The SMART Safety: An empirical dataset for evidence synthesis of adverse events.Data in brief · 2023Article
- Infective Endocarditis Risk with Melody versus Sapien Valves Following Transcatheter Pulmonary Valve Implantation: A Systematic Review and Meta-Analysis of Prospective Cohort Studies.Journal of clinical medicine · 2023Article
- Effect of important modifiers on harmful effects in evidence synthesis practice of adverse events were insufficiently investigated: an empirical investigation.BMC medical research methodology · 2023Article
- An empirical comparison of the harmful effects for randomized controlled trials and non-randomized studies of interventions.Frontiers in pharmacology · 2023Article
- Evidence synthesis practice: why we cannot ignore studies with no events?Journal of general internal medicine · 2022Article
- Validity of data extraction in evidence synthesis practice of adverse events: reproducibility study.BMJ (Clinical research ed.) · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundsZero-events studies frequently occur in systematic reviews of adverse events, which consist of an important source of evidence. We aimed to examine how evidence of zero-events studies was utilized in the meta-analyses of systematic reviews of adverse events.
methodsWe conducted a survey of systematic reviews published in two periods: January 1, 2015, to January 1, 2020, and January 1, 2008, to April 25, 2011. Databases were searched for systematic reviews that conducted at least one meta-analysis of any healthcare intervention and used adverse events as the exclusive outcome. An adverse event was defined as any untoward medical occurrence in a patient or subject in healthcare practice. We summarized the frequency of occurrence of zero-events studies in eligible systematic reviews and how these studies were dealt with in the meta-analyses of these systematic reviews.
resultsWe included 640 eligible systematic reviews. There were 406 (63.45%) systematic reviews involving zero-events studies in their meta-analyses, among which 389 (95.11%) involved single-arm-zero-events studies and 223 (54.93%) involved double-arm-zero-events studies. The majority (98.71%) of these systematic reviews incorporated single-arm-zero-events studies into the meta-analyses. On the other hand, the majority (76.23%) of them excluded double-arm-zero-events studies from the meta-analyses, of which the majority (87.06%) did not discuss the potential impact of excluding such studies. Systematic reviews published at present (2015-2020) tended to incorporate zero-events studies in meta-analyses than those published in the past (2008-2011), but the difference was not significant (proportion difference=-0.09, 95% CI -0.21 to 0.03, p = 0.12).
conclusionSystematic review authors routinely treated studies with zero-events in both arms as "non-informative" carriers and excluded them from their reviews. Whether studies with no events are "informative" or not largely depends on the methods and assumptions applied, thus sensitivity analyses using different methods should be considered in future meta-analyses.
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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.