Methodological Quality and Publication Bias in Observational Studies on Risk of Rupture of Unruptured Intracranial Aneurysms

To the Editor:We would like to comment on some aspects of the very interesting updated meta-analysis on risk of rupture of unruptured intracranial aneurysms by Wermer and colleagues.1First, with regard to the assessment of methodological quality of the included studies, the authors have rated studies as “good” when they fulfilled 3 criteria with regard to design, completeness of follow-up and certainty of diagnosis of subarachnoid hemorrhage. Several other studies have stressed that accounting for confounders …