Meta-analysis: ondansetron for vomiting in acute gastroenteritis in children
Abstract
Sir, We read with interest the publication ‘Meta-analysis: ondansetron for vomiting in acute gastroenteritis in children’.1 The work of these authors appears to follow from our Cochrane review2 on the same subject and we would like to take this opportunity to highlight the differences, and to express our doubts about the validity of their meta-analyses. The fundamental difference between the two reviews, aside from the fact that our review was undertaken without prior knowledge of the trials that would be included, is the authors’ decision to pool the data in meta-analyses. The validity of any such decision is dependent on the clinical homogeneity of the included studies. This should be assessed by examining the characteristics of the eligible studies, to assess the similarities and differences among the types of participants, interventions and outcome measures. Szajewska et al. touch on this in their Discussion section, by noting that ‘the statistical conclusions on determinants of heterogeneity maybe flawed’, but still decide to present a meta-analysis. Factors such as the route of administration of the drug influence the applicability and clinical relevance of the trial results, as well as the decision on whether they are similar enough to combine. As we discussed in our Cochrane review, because some trials administered the drug intravenously and other trials used the oral route, meta-analyses would seem to be inappropriate and, comparisons of the results of the trials…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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