Evidence map›Paper›PMID 34692962›Full record

ArticleArthroplasty today2021

Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review.

Carl L Herndon, Kyle L McCormick, Anastasia Gazgalis, Elise C Bixby, Matthew M Levitsky, Alexander L Neuwirth

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In one paragraph

Article in Arthroplasty today, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 6 pooled it
–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

14 citing papers in PubMed, 6 syntheses or guidelines pooled it.

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  4. The fragility index and reverse fragility index of FDA investigational device exemption trials in spinal fusion surgery: a systematic review.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Carl L HerndonDepartment of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
Kyle L McCormickDepartment of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
Anastasia GazgalisDepartment of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
Elise C BixbyDepartment of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
Matthew M LevitskyDepartment of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
Alexander L NeuwirthDepartment of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe Fragility Index (FI) and Reverse Fragility Index are powerful tools to supplement the

methodsWe performed a systematic review of RCTs in TJA over the last decade. For each study, we calculated the FI (for statistically significant outcomes) or Reverse Fragility Index (for nonstatistically significant outcomes) for all dichotomous, categorical outcomes. We also used the Pearson correlation coefficient to evaluate publication-level variables.

resultsWe included 104 studies with 473 outcomes; 92 were significant, and 381 were nonstatistically significant. The median FI was 6 overall and 4 and 7 for significant and nonsignificant outcomes, respectively. There was a positive correlation between FI and sample size (R = 0.14,

conclusionsThis study is the largest evaluation of FI in orthopedics literature to date. We found a median FI that was comparable to or higher than FIs calculated in other orthopedic subspecialties. Although the mean and median FIs were greater than the 2 recommended by the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines to demonstrate strong evidence, a large percentage of studies have an FI < 2. This suggests that the TJA literature is on par or slightly better than other subspecialties, but improvements must be made. LEVEL OF EVIDENCE: Level I; Systematic Review.

Indexed as

Fragility indexRandomized controlled trialsStatistical significanceTotal joint arthroplasty

Identifiers

PMID34692962
PMCPMC8517286

What OpenQuestion holds

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Registered trials

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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.