El papel de las revisiones sistemáticas. Comentarios
Haris Vasiliadis2011, Revista Colombiana de Anestesiología
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Revista Colombiana de Anestesiología
ISSN: 0120-3347
[email protected]
Sociedad Colombiana de Anestesiología y
Reanimación
Colombia
Hidalgo Ottolenghi, Ricardo
El papel de las revisiones sistemáticas. Comentarios
Revista Colombiana de Anestesiología, vol. 39, núm. 4, noviembre-enero, 2011, pp. 610-613
Sociedad Colombiana de Anestesiología y Reanimación
Bogotá, Colombia
Disponible en: http://www.redalyc.org/articulo.oa?id=195122513013
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Rev. Colomb. Anestesiol. Noviembre 2011 - enero 2012. Vol. 39 - No. 4: 610-611 (doi:10.5554/rca.v39i4.277)
Carta
al
edItor
El papel de las revisiones sistemáticas.
Comentarios
the Role of Systematic Reviews.
Comments
Ricardo Hidalgo Ottolenghi*
H
e revisado con gran interés el elegante
artículo "El papel de las revisiones sistemáticas en anestesiología basada en
evidencias" (1).
Al respecto, considero necesario hacer algunas
observaciones:
El subtítulo "Revisiones sistemáticas: útiles, mas
no siempre creíbles" es confuso y no responde a
la lógica del razonamiento, veamos por qué:
¿Podemos decir que es "útil" una herramienta
sobre la cual tenemos poca conianza o sobre
cuyo contenido y estructura, entre otros, existen dudas?
¿Cómo puede ser útil un instrumento sobre cuya
veracidad existen cuestionamientos? –No puede
haber credibilidad si no hay verdad–.
En este punto, he pensado que lo que se quiso decir fue que las Revisiones Sistemáticas
pueden ser útiles, pero que no siempre son
consistentes.
En otra parte del texto se dice "(...) Por otra parte, las evidencias de los ensayos clínicos están
sujetas a diversos grados de credibilidad (...)”.
*
I
have reviewed with great interest the article
entitled “The role of systematic reviews in evidence-based anesthesiology” (1), and I have
the following remarks.
The subtitle – “Systematic reviews: useful but
not always credible” - is confusing and inconsistent with the reasoning, for the following
reasons:
Are we allowed to say that a tool is useful when
we cannot fully trust it or when we harbor
doubts about its content and structure?
How can a tool be useful if there are doubts
about its veracity? There cannot be credibility
without truth.
Regarding this point, I believe that what the author meant was that Systematic Reviews may
be useful, but are not always consistent.
Later on in the text we read, “On the other
hand, evidence from clinical trials is subject to
varying degrees of credibility”.
Can we refer to EVIDENCE from clinical trials,
or rather OUTCOMES of clinical trials?
Are these degrees on the SCALE OF EVIDENCE
(according to their source, methodology, among
others), or are these degrees of credibility?
Cardiólogo. Centro Ecuatoriano Cochrane. Decano, Facultad Ciencias de la Salud Eugenio Espejo. Universidad
Tecnológica Equinoccial. Quito, Ecuador. Correspondencia: Universidad Tecnológica Equinoccial. Avda. Occidental
s/n y Mariana de Jesús. Facultad de Ciencias de la Salud – UTE. Quito, Ecuador. Correo electrónico: [email protected]
El papel de las revisiones sistemáticass. Comentarios
he Role of Systematic Reviews. Comments 611
¿Son ‘evidencias’ de los ensayos clínicos, o son
más bien ‘resultados’ de estos?
¿Se trata de grados en la Escala de Evidencias
(de acuerdo a su origen, la metodología utilizada, etc.), o de grados de credibilidad?
Si es así, ¿cómo podemos hablar de ‘grados de
credibilidad’, teniendo en cuenta que se trata
de un concepto que tiene un componente subjetivo, mientras que, en cambio, la ‘Escala de
Evidencias’ debe ser, ante todo y precisamente,
muy objetiva?
How is it possible to refer to DEGREES OF
CREDIBILITY, considering that credibility itself
has a component of subjectivity, while a SCALE
OF EVIDENCE must be, above all, very objective?
Based on these comments, it would be important to clarify these concepts in order to avoid
misunderstandings, not only semantic but also
epistemological, considering that this article
is addressed to people who are just starting to
delve into this subject.
Por lo comentado, valdría la pena que se aclaren estos conceptos, los cuales pueden derivar en
malentendidos, no solo semánticos, sino también
epistemológicos, ya que el artículo está dirigido
especialmente a quienes se inician en el tema.
1.
REfEREnCIAS
Vasiliadis, HS, Martí-Carvajal, A, Salanti, G. El papel de las revisiones sistemáticas en anestesiología basada en la
evidencia. [Editorial]. Rev. Colomb. Anestesiol. 2011;39(2):163-171. DOI:10.5554/rcav39i
Conlicto de intereses: Ninguno declarado.
financiación: Ninguna.
Rev. Colomb. Anestesiol. Noviembre 2011 - enero 2012. Vol. 39 - No. 4: 612-613 (doi:10.5554/rca.v39i4.277)
rePlICa
El papel de las revisiones sistemáticas.
Comentarios
the Role of Systematic Reviews.
Comments
Haris S. Vasiliadis*, Arturo Martí-Carvajal**, Georgia Salanti***
E
s importante que los investigadores y clínicos se aproximen de manera crítica a
toda la información publicada, incluidos
los resultados de los Ensayos Clínicos Aleatorizados o las Revisiones Sistemáticas.
Los Ensayos Clínicos Aleatorizados se consideran la fuente más coniable de información entre
los estudios de investigación primaria. Sin embargo, no debemos aceptar sus conclusiones de
plano, sencillamente porque provengan de un
estudio presentado como ensayo clínico aleatorizado. Por esa razón se han desarrollado herramientas para evaluar la credibilidad de la información suministrada. Por ejemplo, los revisores
evalúan la validez del método de aleatorización,
la calidad del ocultamiento de la asignación, o la
eicacia del cegamiento. (1).
Las Revisiones Sistemáticas también son susceptibles de sesgo en lo que se reiere a la calidad de los ensayos clínicos aleatorizados y el
proceso mismo de revisión. Por esa razón, hay
herramientas que pueden usarse para evaluar
*
I
t is important for researchers and clinical
practitioners to approach critically any published information; including results from
Randomized Control Trials (RCT) or Systematic
Reviews (SR).
RCTs are considered the most reliable source
of information among primary research study
designs. However, we should not accept their
conclusions ‘at face value’ just because a study
is presented as an RCT. Therefore, tools have
been developed to evaluate the credibility of the
provided information. For example, reviewers
evaluate the validity of the method of randomization, the quality of allocation concealment or
the effectiveness of blinding (1).
Systematic Reviews are also prone to bias associated with the quality of the included RCTs
and the review process itself. For this purpose
tools are available which can be used to evaluate the quality of a systematic review and include items regarding the availability of the protocol, the methodology followed, the outcomes’
MD, PhD. Molecular Cell Biology and Regenerative Medicine, Sahlgrenska Academy, University of Gothenburg,
Sweden. Correspondencia: Neokaisareia, PO Box 363, 45500, Ioannina, Greece. Correo electrónico:[email protected].
** MD, MSc. Universidad de Carabobo and Iberoamerican Cochrane Network, Valencia, Venezuela. Correo electrónico:
[email protected]
*** PhD. Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece. Correo
electrónico: gsalanti@ cc.uoi.gr
El papel de las revisiones sistemáticass. Comentarios
613
he Role of Systematic Reviews. Comments
la calidad de las revisiones sistemáticas y que
incluyen elementos relativos a la disponibilidad
del protocolo, la metodología empleada, el procesamiento de los resultados y la presencia de
sesgos de publicación (AMSTAR) (2).
El término ‘evidencia’ no tiene por objeto caracterizar una información objetiva y completamente imparcial (1). Puede referirse a evidencia
de un grado alto o bajo de credibilidad. Por consiguiente, el término ‘calidad de la evidencia’
también se utiliza ampliamente en el Manual
Cochrane. La evidencia emanada de los artículos cientíicos es, y debe seguir siendo, tema de
evaluación y valoración crítica constante. Por
esa razón, el Grupo de Trabajo GRADE desarrolló una herramienta para analizar el grado
de calidad de la evidencia (3). Como respuesta
a los comentarios de Hidalgo R (4).
1.
2.
processing and the presence of publication bias
(AMSTAR) (2).
The term ‘evidence’ is not meant to characterize an objective and completely bias-free piece
of information (1). It can be evidence of low or
high credibility. Consequently, the term ‘quality of evidence’ is also widely used in the Cochrane Handbook. The evidence provided by
scientiic papers is, and should remain, the
subject to constant critical appraisal and evaluation. Therefore, the GRADE Working Group
has developed a tool for grading the quality of
evidence (3). As response to the comments of
Hidalgo R (4).
REfEREnCIAS
Vasiliadis HS, Martí-Carvajal A, Salanti G. El papel
de las revisiones sistemáticas en anestesiología basada en la evidencia. [Editorial]. Rev. Colomb. Anestesiol. 2011;39(2):163-171. DOI:10.5554/rcav39i.
Shea BJ, Hamela C, Wellsd GA, Bouterb LM, Kristjanssonf E, Grimshawg J, et al. AMSTAR is a reliable
and valid measurement tool to assess the methodolo-
Conlicto de intereses: Ninguno declarado.
financiación: Ninguna.
3.
4.
gical quality of systematic reviews. J. Clin. Epidemiol
2009;62(10):1013-20.
Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y,
Flottorp S, et al. GRADE Working Group. Grading
quality of evidence and strength of recommendations. BMJ 2004 Jun 19;328(7454):1490.
Hidalgo R. The Role of Systematic Reviews. Comments (Letter to Editor). Rev. Colomb. Anestesiol.
2011; 39(4): 614-5.
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