Why we need a broad perspective on meta-analysis

doi:10.1136/bmj.321.7261.585

BMJ 2000;321:585-586 ( 9 September )

Editorials

Why we need a broad perspective on meta-analysis

It may be crucially important for patients

The first 150 words of the full text of this article appear below.

In the world of clinical trials and meta-analyses there is an important debate between the "lumpers" and the "splitters."This relates to whether the overall findings of clinical trialsand meta-analyses are the appropriate outcome to apply to individuals(lumping) or whether it is better to try to match the characteristicsof particular patients to characteristics of subgroups withintrials or meta-analyses (splitting). Although the splitters' viewseems intuitively correct, there are usually substantial clinicaland methodological advantages tolumping.

The generalisability and usefulness of meta-analyses are increased considerably if the individual trials cover different patientpopulations, settings, and concomitant routine care. For example,when a meta-analysis showed that the use of human albumin increasedmortality¹ this result applied to all three groups of criticallyill patients studied. For patients with hypovolaemia the differencewas not conventionally significant (95% confidence interval forthe odds ratio 0.99 to 3.15), but it would . . . [Full text of this article]

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