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• W2003444887 abstract "Archives of Facial Plastic SurgeryVol. 9, No. 2 Editor’s Correspondence: Comments & OpinionsFree AccessComparing Apples to Oranges in Meta-analysis StudiesJohn S. RheeJohn S. RheeCorrespondence: Dr Rhee, Department of Otolaryngology and Communication Sciences, MCW Clinic at Froedtert West, 9200 W Wisconsin Ave, Milwaukee, WI 53226 E-mail Address: jrhee@mcw.eduSearch for more papers by this authorPublished Online:1 Mar 2007https://doi.org/10.1001/archfaci.9.2.139-bAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail As an avid proponent of evidence-based medicine, I read with great interest the recent article by Leventhal et al.1 I laud the efforts of the authors for their diligent work in compiling much of the existing literature on this topic. However, I disagree with the authors in their methods, interpretation of the results, and the appropriateness of using meta-analysis for this group of studies.The supposition that a keloid has a 50% likelihood of improvement by chance alone is arguably erroneous. We do not fully understand the natural history of keloids, but clinical experience tells us that the rate of spontaneous improvement for this disease process is closer to 0% than 50%. More important, the use of meta-analysis on this heterogeneous group of studies is truly like comparing apples to oranges. The conclusion that “there was no statistically significant difference between treatments”1(p362) is particularly misleading. The null hypothesis is purported as being upheld, but in reality, no meaningful comparisons or conclusions can be made by pooling the data of these markedly heterogeneous studies.In the paradigm of evidence-based medicine, a well-performed meta-analysis study is touted as the highest level of evidence. Quite simply, a meta-analysis is a statistical analysis of the results of independent studies, which generally aims to produce a single estimate of a treatment effect.2 When used appropriately, it is a powerful tool in pooling data from small yet similar studies, especially randomized controlled trials (RCTs). However, one must be cautious when using this type of analysis in studies other than RCTs owing to bias and differing outcomes and end points. Even with a collection of RCTs, sometimes the heterogeneity of the studies will dictate that a meta-analysis not be performed.3The article is not without its merits as a solid review of the literature as dictated by the limits of a PubMed search. The authors do point out existing holes in the literature and point to areas for future research such as a well-designed RCT comparing treatment modalities with similar end points.In conclusion, the applicability of a meta-analysis is dictated in large measure by the quality of the existing literature. Unfortunately, we are a specialty that is short on RCTs and other well-constructed prospective trials. Nevertheless, we need to be judicious in how we distill the evidence from the existing literature and how it is presented to the readership. The conclusions that are drawn from ill-devised meta-analyses can be disproportionately misleading and influential to the novice reader or interested stakeholder.References1. Leventhal D, Furr M, Reiter D. Treatment of keloids and hypertrophic scars: a meta-analysis and review of the literature. Arch Facial Plast Surg. 2006;8:362-368.17116782 Link, Google Scholar2. Egger M, Smith GD, O’Rourke K. Rationale, potentials, and promise of systematic reviews. In: Egger M, Smith GD, Altman DG, eds. Systematic Reviews in Health Care: Meta-analysis in Context, 7th Impression. London, England: BMJ Publishing Group; 2006:5 Google Scholar3. Rosenfeld RM. Meta-analysis. ORLJ Otorhinolaryngol Relat Spec. 2004;66:186-195.15467343 Medline, Google ScholarFiguresReferencesRelatedDetails Volume 9Issue 2Mar 2007 InformationCopyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:John S. Rhee.Comparing Apples to Oranges in Meta-analysis Studies.Archives of Facial Plastic Surgery.Mar 2007.139-140.http://doi.org/10.1001/archfaci.9.2.139-bPublished in Volume: 9 Issue 2: March 1, 2007PDF download" @default.
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