Open Access

Faulty risk-of-bias assessment in a meta-analysis of hydroxyethyl starch for non-septic ICU patients: a rebuttal

  • Michael James1Email author,
  • Ivan Joubert2,
  • William Lance Michell3,
  • Andrew Nicol4,
  • Pradeep Navsaria4 and
  • Rencia Gillespie1
Critical Care201519:444

https://doi.org/10.1186/s13054-015-1168-2

Published: 24 December 2015

The original article was published in Critical Care 2015 19:357

The Fluids in Resuscitation of Severe Trauma (FIRST) study meets all of the criteria for assessment as a low risk of bias study, contrary to the unsupported allegations by Bayer and Reinhardt.

We dispute the letter from Bayer and Reinhart together with the response from He et al. [1]. Bayer and Reinhart claim that the FIRST study [2] has a high risk of bias and cite two non-peer-reviewed letters from themselves and Finfer to support this claim. However, these authors fail to cite the extensive responses that more than adequately cover their queries [3].

Bayer and Reinhart claim that there was selective outcome reporting, but all of the outcomes listed in the methods of the FIRST trial have been reported. As with all published work, space constraints imposed by the journal limit the amount of detail that can be included. In our paper all statistically significant results were reported in detail and other outcomes that were not significant were only reported briefly as is the norm. These non-significant outcomes were more than adequately addressed in the subsequent correspondence. There is therefore no basis for the claim that this study shows a high risk of bias. Indeed, in the initial letter from Bayer and Reinhart, their own bias is clearly illustrated in their attempts to draw inferences from non-significant data.

In our view, the FIRST study meets all of the criteria for assessment as a low risk of bias study and we dispute the concession made by He et al. [4] regarding the risk of bias of this study. Our view is that the original analysis in the published paper reflects the correct scientific position and that the modified Jadad score of 6 allocated to this study is appropriate.

Notes

Abbreviation

FIRST: 

Fluids in Resuscitation of Severe Trauma

Declarations

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Department of Anaesthesia, University of Cape Town and Groote Schuur Hospital
(2)
Division of Critical Care and Department of Anaesthesia, University of Cape Town and Groote Schuur Hospital
(3)
Division of Critical Care and Department of Surgery, University of Cape Town and Groote Schuur Hospital
(4)
Trauma Unit, Division of General Surgery, University of Cape Town and Groote Schuur Hospital

References

  1. Bayer O, Reinhart K. Faulty risk-of-bias assessment in a meta-analysis of hydroxyethyl starch for nonseptic ICU patients. Crit Care. 2015;19:357.PubMedPubMed CentralView ArticleGoogle Scholar
  2. James MF, Michell WL, Joubert IA, Nicol AJ, Navsaria PH, Gillespie RS. Resuscitation with hydroxyethyl starch improves renal function and lactate clearance in penetrating trauma in a randomized controlled study: the FIRST trial (Fluids in Resuscitation of Severe Trauma). Br J Anaesth. 2011;107:693–702.PubMedView ArticleGoogle Scholar
  3. James MFM, Michell WL, Joubert IA, Nicol AJ, Navsaria PH, Gillespie RS. Reply from the authors. Br J Anaesth. 2012;108:160–1.View ArticleGoogle Scholar
  4. He B, Xu B, Xu X, Li L, Ren R, Chen Z, et al. Hydroxyethyl starch versus other fluids for non-septic patients in the intensive care unit: a meta-analysis of randomized controlled trials. Crit Care. 2015;19:92.PubMedPubMed CentralView ArticleGoogle Scholar

Copyright

© James et al. 2015

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