Reed A.C. Siemieniuk, MD; Pablo Alonso-Coello, MD, PhD; Gordon H. Guyatt, MD, MSc
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterest Forms.do?msNum=M15-0715.
Siemieniuk R., Alonso-Coello P., Guyatt G.; Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia. Ann Intern Med. 2016;164:636-637. doi: 10.7326/L15-0583
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Published: Ann Intern Med. 2016;164(9):636-637.
The widely used DL method for summarizing random effects (1) has been criticized for sometimes having inappropriately narrow CIs and high type I error rates (2, 3). The HKSJ method, which is based on a t-distribution, is a popular alternative because it is straightforward and does not require familiarity with advanced statistical programs (3).
We agree with Drs. Singh and Jaiswal that the HKSJ 95% CIs are implausibly narrow in the mechanical ventilation subgroup analysis, especially in the subgroup of studies enrolling patients with more severe pneumonia. This led to a statistically significant interaction between pneumonia severity and the corticosteroid effect (P = 0.01), which would not otherwise have occurred using the DL method (P = 0.18). Nevertheless, as we discuss in the article and regardless of this interaction, we believe that the apparent subgroup effect is spurious and that corticosteroids are probably beneficial across the range of pneumonia severities. Our findings and our confidence in them, summarized in the GRADE (Grading of Recommendations Assessment, Development and Evaluation) summary of findings table, are the same for all outcomes using either the DL or the HKSJ approach.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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