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Factorial design provides evidence to guide practice of anaesthesia
Author(s) -
Korttila K.,
Apfel C. C.
Publication year - 2005
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2005.00622.x
Subject(s) - medicine , randomized controlled trial , meta analysis , systematic review , medline , evidence based medicine , alternative medicine , medical literature , clinical practice , research design , gold standard (test) , medical physics , family medicine , surgery , statistics , pathology , mathematics , political science , law
Many scientific articles are written merely to get something published, neglecting the clinician who would like the medical literature to guide their practice. Evidence‐based medicine is expected to help in clinical decision‐making. Systematic reviews of the literature followed by a meta‐analysis of randomized, controlled trials (RCT) have claimed to represent the highest strength of evidence. However, the results published in meta‐analyses have not always been confirmed in subsequent large RCTs. An analysis of 12 large RCTs and 19 meta‐analyses addressing the same questions found that the outcomes of these large RCTs were not predicted accurately 35% of the time by previously published meta‐analyses. Therefore, meta‐analyses of several small RCTs do not obviate the need for large, multicentre RCTs, which can still be considered as a gold standard for the development of clinical guidelines or practice plans. Moreover, large RCTs using a factorial design can be highly efficient because they can answer several clinical questions at the same time and offer the only systematic approach to investigate an interaction of combinations in multimodal approaches.