• Laura Clark, Caroline Fairhurst, Catherine E Hewitt, Yvonne Birks, Sally Brabyn, Sarah Cockayne, Sara Rodgers, Katherine Hicks, Robert Hodgson, Elizabeth Littlewood, and David J Torgerson.
• Department of Health Sciences, York Trials Unit, University of York, York YO10 5DD, United Kingdom. Electronic address: Laura.clark@york.ac.uk.
• J Clin Epidemiol. 2014 Sep 1; 67 (9): 1016-24.

BackgroundThere is evidence to suggest that component randomized controlled trials (RCTs) within systematic reviews may be biased. It is important that these reviews are identified to prevent erroneous conclusions influencing health care policies and decisions.PurposeTo assess the likelihood of bias in trials in 12 meta-analyses.DesignA review of 12 systematic reviews.Data SourcesTwelve recently published systematic reviews with 503 component randomized trials, published in the British Medical Journal, The Lancet, Journal of the American Medical Association, and The Annals of Internal Medicine before May 2012.Study Selection And Data ExtractionSystematic reviews were eligible for inclusion if they included only RCTs. We obtained the full text for the component RCTs of the 12 systematic reviews (in English only). We extracted summary data on age, number of participants in each treatment group, and the method of allocation concealment for each RCT.Data SynthesisFive of the 12 meta-analyses exhibited heterogeneity in age differences (I(2) > 0.30), when there should have been none. In two meta-analyses, the age of the intervention group was significantly greater than that of the control group. Inadequate allocation concealment was a statistically significant predictor of heterogeneity in one trial as observed by a metaregression.ConclusionsMost of the sample of recent meta-analyses showed that there were signs of imbalance and/or heterogeneity in ages between treatment groups, when there should have been none. Systematic reviewers might consider using the techniques described here to assess the validity of their findings.Copyright © 2014 Elsevier Inc. All rights reserved.

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