ArticlePloS one2022
Assessing and visualizing fragility of clinical results with binary outcomes in R using the fragility package.
Article in PloS one, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 3 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
18 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Mineralocorticoid receptor antagonists and mortality in hypertension: a systematic review and meta-analysis.Journal of hypertension · 2026Pooled it
- A systematic review of the methodological quality of randomised trials in IBD surgery.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2026Pooled it
- How Robust is the Evidence for Prehabilitation in Cancer Surgery?: A Systematic Review and Fragility Index Analysis.Annals of surgical oncology · 2026Pooled it
- Determining the Conclusiveness of Systematic Review Evidence : A Scoping Review of Methodological Approaches.Annals of internal medicine · 2026Article
- Nonattainability of the Fragility Index.Cureus · 2026Article
- Fragility of Evidence for the Efficacy of Anti-Fracture Medications.The Journal of clinical endocrinology and metabolism · 2025Article
- Evaluating the properties of the fragility index of meta-analyses.BMC medical research methodology · 2025Article
- A scoping review on metrics to quantify reproducibility: a multitude of questions leads to a multitude of metrics.Royal Society open science · 2025Review
- The Role of Double-Zero-Event Studies in Evidence Synthesis: Evaluating Robustness Using the Fragility Index.Journal of evaluation in clinical practice · 2025Article
- Living alone predicts non-home discharge post elective hip arthroplasty: A matched-pair cohort study.PloS one · 2025Article
- Lupus nephritis randomised controlled trials: evidence gaps and under-represented groups.Lupus science & medicine · 2024Article
- Robustness Assessment of Oncology Dose-Finding Trials Using the Modified Fragility Index.Cancers · 2024Article
- Fragility analysis and systematic review of patellar resurfacing versus non-patellar resurfacing in total knee arthroplasty.Journal of experimental orthopaedics · 2024Article
- Comprehensive analyses of mitophagy-related genes and mitophagy-related lncRNAs for patients with ovarian cancer.BMC women's health · 2024Article
- Article
- Empirical assessment of fragility index based on a large database of clinical studies in the Cochrane Library.Journal of evaluation in clinical practice · 2023Article
- Assessing the robustness of results from clinical trials and meta-analyses with the fragility index.American journal of obstetrics and gynecology · 2023Review
- Assessing and visualizing fragility of clinical results with binary outcomes in R using the fragility package.PloS one · 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
2 authors.
Funding
Abstract
With the growing concerns about research reproducibility and replicability, the assessment of scientific results' fragility (or robustness) has been of increasing interest. The fragility index was proposed to quantify the robustness of statistical significance of clinical studies with binary outcomes. It is defined as the minimal event status modifications that can alter statistical significance. It helps clinicians evaluate the reliability of the conclusions. Many factors may affect the fragility index, including the treatment groups in which event status is modified, the statistical methods used for testing for the association between treatments and outcomes, and the pre-specified significance level. In addition to assessing the fragility of individual studies, the fragility index was recently extended to both conventional pairwise meta-analyses and network meta-analyses of multiple treatment comparisons. It is not straightforward for clinicians to calculate these measures and visualize the results. We have developed an R package called "fragility" to offer user-friendly functions for such purposes. This article provides an overview of methods for assessing and visualizing the fragility of individual studies as well as pairwise and network meta-analyses, introduces the usage of the "fragility" package, and illustrates the implementations with several worked examples.
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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.