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2015 ; 5
(9
): e009368
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Reporting, handling and assessing the risk of bias associated with missing
participant data in systematic reviews: a methodological survey
#MMPMID26423858
Akl EA
; Carrasco-Labra A
; Brignardello-Petersen R
; Neumann I
; Johnston BC
; Sun X
; Briel M
; Busse JW
; Ebrahim S
; Granados CE
; Iorio A
; Irfan A
; Martínez García L
; Mustafa RA
; Ramírez-Morera A
; Selva A
; Solà I
; Sanabria AJ
; Tikkinen KA
; Vandvik PO
; Vernooij RW
; Zazueta OE
; Zhou Q
; Guyatt GH
; Alonso-Coello P
BMJ Open
2015[Sep]; 5
(9
): e009368
PMID26423858
show ga
OBJECTIVES: To describe how systematic reviewers are reporting missing data for
dichotomous outcomes, handling them in the analysis and assessing the risk of
associated bias. METHODS: We searched MEDLINE and the Cochrane Database of
Systematic Reviews for systematic reviews of randomised trials published in 2010,
and reporting a meta-analysis of a dichotomous outcome. We randomly selected 98
Cochrane and 104 non-Cochrane systematic reviews. Teams of 2 reviewers selected
eligible studies and abstracted data independently and in duplicate using
standardised, piloted forms with accompanying instructions. We conducted
regression analyses to explore factors associated with using complete case
analysis and with judging the risk of bias associated with missing participant
data. RESULTS: Of Cochrane and non-Cochrane reviews, 47% and 7% (p<0.0001),
respectively, reported on the number of participants with missing data, and 41%
and 9% reported a plan for handling missing categorical data. The 2 most reported
approaches for handling missing data were complete case analysis (8.5%, out of
the 202 reviews) and assuming no participants with missing data had the event
(4%). The use of complete case analysis was associated only with Cochrane reviews
(relative to non-Cochrane: OR=7.25; 95% CI 1.58 to 33.3, p=0.01). 65% of reviews
assessed risk of bias associated with missing data; this was associated with
Cochrane reviews (relative to non-Cochrane: OR=6.63; 95% CI 2.50 to 17.57,
p=0.0001), and the use of the Grading of Recommendations Assessment, Development
and Evaluation (GRADE) methodology (OR=5.02; 95% CI 1.02 to 24.75, p=0.047).
CONCLUSIONS: Though Cochrane reviews are somewhat less problematic, most Cochrane
and non-Cochrane systematic reviews fail to adequately report and handle missing
data, potentially resulting in misleading judgements regarding risk of bias.