Paeds Vivas · professional-practice-and-evidence
Interpreting a systematic review — branching viva
Viva on interpreting a systematic review and a clinical practice guideline for a paediatric patient.
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Target exams
RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Journal club: you are given a meta-analysis claiming a new therapy halves the risk of a serious complication in children; the abstract reports a 50 percent relative pooled effect, an I-squared of 65 percent, an asymmetric funnel plot, and industry funding. A guideline cites this review to issue a strong recommendation.
Opening (candidate)
I would treat this as a structured appraisal of the synthesis and the guideline, not a result handover. First I would confirm the question was focused and preregistered, then read the PRISMA flow for the breadth and reproducibility of the search, then score the review's risk of bias with AMSTAR-2 before reading the pooled effect, then quantify heterogeneity and check the funnel plot, and finally rate the certainty with GRADE and weigh applicability to the child. [1] [2] [10]
References6ShowHide
- [1]Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 2021.PMID 33782057
- [2]Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017.PMID 28935701
- [4]Higgins JP, Thompson SG, Deeks JJ, Altman DG Measuring inconsistency in meta-analyses. BMJ, 2003.PMID 12958120
- [7]Alonso-Coello P, Oxman AD, Moberg J, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction. BMJ, 2016.PMID 27365494
- [8]Andrews J, Guyatt G, Oxman AD, et al. GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. Journal of clinical epidemiology, 2013.PMID 23312392
- [10]Murad MH, Montori VM, Ioannidis JP, et al. How to read a systematic review and meta-analysis and apply the results to patient care: users' guides to the medical literature. JAMA, 2014.PMID 25005654