Abstract
Systematic review is a type of research that attempts to identify and summarize all
of the evidence related to a specific research question. It can be thought of as a
“pause” in the process of conducting research in a particular area, in which the following
questions are asked: Based on all of the available evidence, what do we know about
this specific question so far, and what future studies should be conducted to clarify
areas of uncertainty? The systematic review arose as an alternative to the traditional
narrative review—which allows authors to pick and choose the studies they discuss
and the depth at which they discuss them—a process prone to bias. By adhering to a
prospectively defined protocol that specifies how studies should be identified, evaluated,
and statistically combined (the statistical process is a component of systematic review
and is called “meta-analysis”), systematic reviews reduce the bias inherent to traditional
narrative reviews. Systematic reviews are an increasingly common form of published
research, and several of the approximately 1000 such studies that are published annually
focus on topics important to infection control professionals. Consequently, it is
essential that infection control professionals and hospital epidemiologists be able
to understand and evaluate the quality of this useful research design. This article
discusses the essential elements of a systematic review, provides a framework for
evaluating the quality of such an article, and will help the infection control professional
and hospital epidemiologist in determining whether the results of such reviews should
change clinical practice.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Infection ControlAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The growth of meta-analytic literature from 1980 to 1993.Eval Health Prof. 1995; 18: 238-251
- Taking advantage of the explosion of systematic reviews: an efficient MEDLINE search strategy.Eff Clin Pract. 2001; 4: 157-162
- Meta-analysis: an update.Mt Sinai J Med. 1996; 63: 216-224
- Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis.Ann Intern Med. 2002; 136: 792-801
- The effectiveness of interventions aimed at increasing handwashing in healthcare workers—a systematic review.J Hosp Infect. 2001; 47: 173-180
- Ventilator associated pneumonia: perspectives on the burden of illness.Intensive Care Med. 2000; 26: S31-S37
- Antibiotic prophylaxis in intensive care units: meta-analyses versus clinical practice.Intensive Care Med. 2000; 26: S38-S44
- Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection: a meta-analysis.JAMA. 1999; 281: 261-267
- Clinical and economic consequences of nosocomial catheter-related bacteriuria.Am J Infect Control. 2000; 28: 68-75
- How consumers and policymakers can use systematic reviews for decision making.Ann Intern Med. 1997; 127: 37-42
- The role of meta-analysis in the regulatory process for foods, drugs, and devices.JAMA. 1999; 281: 830-834
- Systematic reviews: synthesis of best evidence for clinical decisions.Ann Intern Med. 1997; 126: 376-380
- Checklists for review articles.BMJ. 1994; 309: 648-651
- Methodologic guidelines for systematic reviews of randomized control trials in health care from the Potsdam Consultation on Meta-Analysis.J Clin Epidemiol. 1995; 48: 167-171
- Quantitative synthesis in systematic reviews.Ann Intern Med. 1997; 127: 820-826
- Systematic reviews in health care: meta-analysis in context.2nd ed. Gardner's UK, London2001
- Users' guides to the medical literature. VI. How to use an overview: Evidence-Based Medicine Working Group.JAMA. 1994; 272: 1367-1371
- Users' guides to the Medical Literature. VIII. How to use clinical practice guidelines. B. What are the recommendations and will they help you in caring for your patients? The Evidence-Based Medicine Working Group.JAMA. 1995; 274: 1630-1632
- Users' Guides to the Medical Literature: XIX. Applying clinical trial results. B. Guidelines for determining whether a drug is exerting (more than) a class effect.JAMA. 1999; 282: 1371-1377
- The efficacy of silver alloy-coated urinary catheters in preventing urinary tract infection: a meta-analysis.Am J Med. 1998; 105: 236-241
- Reviewing the reviews: how strong is the evidence; how clear are the conclusions?.Int J Technol Assess Health Care. 2001; 17: 457-466
- Methodology and reports of systematic reviews and meta-analyses: a comparison of Cochrane reviews with articles published in paper-based journals.JAMA. 1998; 280: 278-280
- The medical review article revisited: has the science improved?.Ann Intern Med. 1999; 131: 947-951
- Meta-analyses of randomized controlled trials.N Engl J Med. 1987; 316: 450-455
- Improving the quality of reports of meta-analyses of randomized controlled trials: the QUOROM statement. Quality of Reporting of Meta- analyses.Lancet. 1999; 354: 1896-1900
- Improving the quality of reporting of randomized controlled trials: the CONSORT statement.JAMA. 1996; 276: 637-639
- Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.JAMA. 2000; 283: 2008-2012
- Prevention of intravascular catheter-related infections.Ann Intern Med. 2000; 132: 391-402
- Designing clinical research.2nd ed. Lippincott Williams & Wilkins, Philadelphia, PA2001
- Selecting the language of the publications included in a meta-analysis: is there a Tower of Babel bias?.J Clin Epidemiol. 1995; 48: 159-163
- Publication bias and clinical trials.Control Clin Trials. 1987; 8: 343-353
- Should unpublished data be included in meta-analyses? Current convictions and controversies.JAMA. 1993; 269: 2749-2753
- Identifying relevant studies for systematic reviews.BMJ. 1994; 309: 1286-1291
- Searching the literature: be systematic in your searching.BMJ. 1993; 307: 66
- Searching the health care literature efficiently: from clinical decision-making to continuing education.Am J Infect Control. 2002; 30: 187-195
- Empirical assessment of effect of publication bias on meta-analyses.BMJ. 2000; 320: 1574-1577
- Efficacy of intravenous magnesium in acute myocardial infarction in reducing arrhythmias and mortality: meta-analysis of magnesium in acute myocardial infarction.Circulation. 1992; 86: 774-779
- Lancet. 1995; 345: 669-685
- Publication bias and research on passive smoking: comparison of published and unpublished studies.JAMA. 1998; 280: 250-253
- Full publication of results initially presented in abstracts: a meta-analysis.JAMA. 1994; 272: 158-162
- The Cochrane Collaboration: preparing, maintaining, and disseminating systematic reviews of the effects of health care.JAMA. 1995; 274: 1935-1938
- Relationship between methodological trial quality and the effects of selective digestive decontamination on pneumonia and mortality in critically ill patients.JAMA. 2001; 286: 335-340
- Assessing the quality of randomized controlled trials: an annotated bibliography of scales and checklists.Control Clin Trials. 1995; 16: 62-73
- The hazards of scoring the quality of clinical trials for meta-analysis.JAMA. 1999; 282: 1054-1060
- Does blinding of readers affect the results of meta-analyses? University of Pennsylvania Meta-analysis Blinding Study Group.Lancet. 1997; 350: 185-186
- Why sources of heterogeneity in meta-analysis should be investigated.BMJ. 1994; 309: 1351-1355
- Is there a “best” way to detect and minimize publication bias? An empirical evaluation.Eval Health Prof. 2001; 24: 109-125
- A comparison of methods to detect publication bias in meta-analysis.Stat Med. 2001; 20: 641-654
- Misleading funnel plot for detection of bias in meta-analysis.J Clin Epidemiol. 2000; 53: 477-484
- Systematic reviews in health care: investigating and dealing with publication and other biases in meta-analysis.BMJ. 2001; 323: 101-105
- The use of meta-analysis in cost-effectiveness analysis: issues and recommendations.Pharmacoeconomics. 1999; 15: 1-8
- The role of economic evaluation in infection control.Am J Infect Control. 2001; 29: 338-344
- Cost-effectiveness of antiseptic-impregnated central venous catheters for the prevention of catheter-related bloodstream infection.JAMA. 1999; 282: 554-560
- Meta-analysis, decision analysis, and cost-effectiveness analysis.2nd ed. Oxford University Press, New York, NY1999
- The promise and problems of meta-analysis.N Engl J Med. 1997; 337: 559-561
- Summing up evidence: one answer is not always enough.Lancet. 1998; 351: 123-127
- “Meta-analysis: statistical alchemy for the 21st century”: discussion. A plea for a more balanced view of meta-analysis and systematic overviews of the effect of health care interventions.J Clin Epidemiol. 1995; 48: 81-86
- The challenge of meta-analysis.J Clin Epidemiol. 1995; 48: 1-4
- Meta-analysis: statistical alchemy for the 21st century.J Clin Epidemiol. 1995; 48: 71-79
- Publication bias: the problem that won't go away.Ann N Y Acad Sci. 1993; 703: 135-148
- Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials.JAMA. 1995; 273: 408-412
- Formulating questions and locating primary studies for inclusion in systematic reviews.Ann Intern Med. 1997; 127: 380-387
- Selecting and appraising studies for a systematic review.Ann Intern Med. 1997; 127: 531-537
Article info
Publication history
San Francisco, California, and Ann Arbor, Michigan
Footnotes
☆Dr Bent is supported by a Career Development Award from the National Center for Complementary and Alternative Medicine (1 K08 AT01338-01). Dr Saint is supported by a Career Development Award from the Health Services Research & Development Program of the Department of Veterans Affairs and a Patient Safety Developmental Center Grant from the Agency for Healthcare Research and Quality (P20-HS11540). Dr Saint has received research support and/or honoraria from Aetna, Aventis, and C. R. Bard and serves as a consultant to Aventis, GlaxoSmithKline, and VeriTech.
Identification
Copyright
© 2004 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
