Not only randomized controlled trials, but also case series should be considered in systematic reviews of rapidly developing technologies

Chambers, Duncan; Rodgers, Mark; Woolacott, Nerys

doi:10.1016/j.jclinepi.2008.12.010

Cited by 121Meta-analysis and systematic reviewsAtrial Fibrillation Management and OutcomesClinical practice guidelines implementation

Not only randomized controlled trials, but also case series should be considered in systematic reviews of rapidly developing technologies

Chambers, Duncan, Rodgers, Mark, Woolacott, Nerys·2009·Journal of Clinical Epidemiology

DOI 10.1016/j.jclinepi.2008.12.010

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Abstract

Objective Case series can influence clinical practice but are often omitted from systematic reviews. We evaluated the contribution of case series to a systematic review of radiofrequency catheter ablation (RFCA) for treatment of atrial fibrillation (AF).Study design and setting Analysis of the results of a systematic review based on a search of 25 electronic databases and Internet sources.Results We included eight controlled trials and 53 case series. Case series provided most patients longest follow-up and data on adverse events and complications. Rates of freedom from arrhythmia were comparable between case series, RFCA arms of controlled trials, and a survey of RFCA centers.Conclusion In the case of RFCA for AF, the case series make a useful contribution to the systematic review. Inclusion of case series can increase the evidence base and strengthen the credibility of a review of an emerging health technology. These advantages must be balanced against the risk of bias associated with the lack of a control group, potential publication bias, overrepresentation of results from specialist centers, and overlap of patients across series. Specification in the review protocol of inclusion criteria for outcomes and quality criteria is recommended to make optimum use of case series.

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Sixteen articles (17%) provided recommendations on the key item "protocol development", with publication dates between 1994 and 2015 (median year 2009).
“Sixteen articles (17%) provided recommendations on the key item “protocol development” (Table 3), [29–44] with publication dates between 1994 and 2015 (median year of publication 2009).”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [32]
Thirty-nine articles (42%) made recommendations on the assessment of quality and risk of bias of individual studies, with publication dates between 1994 and 2016 (median year 2009).
“Thirty-nine articles (42%) made recommendations on the assessment of quality and risk of bias of individual studies, [12, 16, 29, 30, 32–35, 37, 38, 43, 47–50, 52–54, 56, 64–66, 70, 71, 73, 75, 77, 82, 84–94] with publication dates between 1994 and 2016 (median year of publication 2009).”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [32]

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Authors: Chambers, D., Rodgers, M., & Woolacott, N.
Affiliations: University of York (GB)
Corresponding author: Chambers, Duncan
ORCID: Chambers, Duncan
Rodgers, Mark
Woolacott, Nerys
Venue: Journal of Clinical Epidemiology
Publisher: Elsevier BV
Published: 2009-12
Volume: 62
Issue: 12
Pages: 1253-1260.e4
ISSN: 0895-4356 (ISSN-L)
DOI: 10.1016/j.jclinepi.2008.12.010
OpenAlex: W1995030115
Cited by: 121
References: 37
Citations by year: 2025: 6 · 2024: 1 · 2023: 4 · 2022: 7 · 2021: 7 · 2020: 13 · 2019: 15 · 2018: 12 · 2017: 5 · 2016: 10 · 2015: 9 · 2014: 10 · 2013: 15 · 2012: 2
FWCI: 0.15
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Clinical Epidemiology (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords: case series, systematic review methodology, radiofrequency catheter ablation, atrial fibrillation, emerging health technologies, evidence base, risk of bias, publication bias, arrhythmia recurrence, adverse events
MeSH terms: Atrial Fibrillation, Humans, Quality Assurance, Health Care, Review Literature as Topic, Technology Assessment, Biomedical, Randomized Controlled Trials as Topic, Catheter Ablation, Evidence-Based Medicine

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