PloS one
Assessing the robustness of meta-analyses to variability in the frequency and timing of postoperative delirium assessment - a novel methodological approach
By Khaled M, Shanthanna H, Thabane L and 18 others.
Abstract
Background
Postoperative delirium (POD) is a fluctuating confusional state occurring early after surgery. Given its fluctuating nature, POD detection is influenced by the frequency and timing of screening. Sparse assessments potentially underestimate the true incidence reported in individual studies, subsequently influencing the weight of studies in meta-analyses, and the results and precision of these meta-analyses.
Objective
To develop a method to evaluate the robustness of meta-analyses to the variation in the frequency and timing of POD assessment across included studies.
Methods
We developed an expert-based scoring system to rate studies according to the confidence that a patient reported not to have POD in the study truly did not, based on the reported timing and frequency of POD assessments. We describe how to use the system to generate hypothetical event rates for studies if the frequency and timing of POD assessment were optimal and how to use these rates in a sensitivity analysis of meta-analyses including these studies. We illustrate the method applying it to two meta-analyses as work examples, one of observational studies and one of randomized controlled trials (RCTs).