Meta‐analysis: ondansetron for vomiting in acute gastroenteritis in children: authors' reply
Abstract
Sirs, We agree that in our meta-analysis, as in almost all, there is extensive clinical heterogeneity. An important question raised by Dr Fedorowicz et al. is whether or not it was appropriate to pool the data given the heterogeneity. The major concern of Dr Fedorowicz et al. was regarding the data in Figure 1, in which we presented data on cessation of vomiting during the first hours and 24 h after the administration of treatment. As stated in our paper, no significant statistical heterogeneity was found for cessation of vomiting in the emergency department, as demonstrated by I2 = 0%. As explained in our paper, I2 can be interpreted as the percentage of the total variation between studies that is attributable to heterogeneity rather than to chance. A value of 0% indicates no observed heterogeneity, and larger values show increasing heterogeneity. Thus, we believe our decision to pool the data was justified. In contrast, heterogeneity was significant for cessation of vomiting in 24 h (I2 = 66%). Acknowledging this, for this outcome measure, as well as for any other if there was statistical heterogeneity, we performed both fixed and random-effects model analyses. The latter one is a statistical model in which both within-study sampling error (variance) and between-study variation are included in the assessment of the uncertainty (confidence interval) of the results of a meta-analysis. Again, we believe that such approach was justified and in line with the recommendation…
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