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Compliance with QUOROM and quality of reporting of overlapping meta-analyses on the role of acetylcysteine in the prevention of contrast associated nephropathy: case study

BMJ 2006; 332 doi: (Published 26 January 2006) Cite this as: BMJ 2006;332:202
  1. Giuseppe G L Biondi-Zoccai, interventionist, PhD student (gbiondizoccai{at},
  2. Marzia Lotrionte, cardiologist3,
  3. Antonio Abbate, internal medicine resident4,
  4. Luca Testa, cardiology fellow3,
  5. Enrico Remigi, postdoctoral fellow5,
  6. Francesco Burzotta, assistant professor3,
  7. Marco Valgimigli, PhD student6,
  8. Enrico Romagnoli, interventionist7,
  9. Filippo Crea, director3,
  10. Pierfrancesco Agostoni, research fellow8
  1. 1 Hemodynamics and Cardiovascular Radiology Service, Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
  2. 2 Institute of Medical Statistics and Biometrics, University of Milan, Milan, Italy
  3. 3 Institute of Cardiology, Catholic University, Rome, Italy
  4. 4 Department of Medicine, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA, USA
  5. 5 School of Engineering, University of KwaZulu-Natal, Durban, South Africa
  6. 6 Thorax Center, Erasmus University Medical Center, Rotterdam, the Netherlands
  7. 7 Department of Cardiology, Catholic University Hospital, Campobasso, Italy
  8. 8 AZ Middelheim Hospital, Antwerp, Belgium
  1. Correspondence to: G G L Biondi-Zoccai
  • Accepted 14 November 2005


Objective To appraise multiple systematic reviews on the same clinical topic, focusing on predictors and correlates of quality of reporting of meta-analysis (QUOROM) scores.

Design Case study.

Setting Reviews providing at least individual quantitative estimates on role of acetylcysteine in the prevention of contrast associated nephropathy.

Data sources PubMed, the database of abstracts of reviews of effects, and the Cochrane database of systematic reviews (updated March 2005).

Main outcome measures Funding, compliance with the QUOROM checklist, scores on the Oxman and Guyatt quality index, and authors' recommendations.

Results 10 systematic reviews, published August 2003 to March 2005, were included. Nine pooled events despite heterogeneity and five recommended routine use of acetylcysteine, whereas the remaining studies called for further research. Compliance with the 18 items on the QUOROM checklist was relatively high (median 16, range 11 to 17), although shorter manuscripts had significantly lower scores (R = 0.73; P = 0.016). Reviewers who reported previous not for profit funding were more likely to score higher on the Oxman and Guyatt quality index. No association was found between QUOROM and Oxman and Guyatt scores (R = −0.06; P = 0.86), mainly because of greater emphasis of the Oxman and Guyatt scores on the appraisal of bias in selection and validity assessment (inadequate in five reviews).

Conclusions Multiple systematic reviews on the same clinical topic varied in quality of reporting and recommendations. Longer manuscripts and previous not for profit funding were associated with higher quality.


  • Embedded ImageDescription of Oxman and Guyatt index is on

  • Competing interests None declared.

  • Contributors GB-Z and PA participated in the study design, data acquisition, analysis, and interpretation, and provided statistical expertise. GB-Z drafted the manuscript and is guarantor. PA critically revised the manuscript. AA, FB, ML, ER, LT, ER, FC, and MV participated in data analysis, interpretation, and critical revisions of the manuscript. AA and FB provided statistical expertise.

  • Funding None.

  • Ethical approval Not required.

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