Systematic reviews and meta-analyses of randomized trials: principles and pitfalls

Da Costa, Bruno R.; Jüni, Peter (2014). Systematic reviews and meta-analyses of randomized trials: principles and pitfalls. European Heart Journal, 35(47), pp. 3336-3345. Oxford University Press 10.1093/eurheartj/ehu424

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Systematic reviews and meta-analyses allow for a more transparent and objective appraisal of the evidence. They may decrease the number of false-negative results and prevent delays in the introduction of effective interventions into clinical practice. However, as for any other tool, their misuse can result in severely misleading results. In this article, we discuss the main steps that should be taken when conducting systematic reviews and meta-analyses, namely the preparation of a review protocol, identification of eligible trials, and data extraction, pooling of treatment effects across trials, investigation of potential reasons for differences in treatment effects across trials, and complete reporting of the review methods and findings. We also discuss common pitfalls that should be avoided, including the use of quality assessment tools to derive summary quality scores, pooling of data across trials as if they belonged to a single large trial, and inappropriate uses of meta-regression that could result in misleading estimates of treatment effects because of regression to the mean or the ecological fallacy. If conducted and reported properly, systematic reviews and meta-analyses will increase our understanding of the strengths and weaknesses of the available evidence, which may eventually facilitate clinical decision making.

Item Type:

Journal Article (Review Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Da Costa, Bruno and Jüni, Peter


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services




Oxford University Press




Doris Kopp Heim

Date Deposited:

05 Jan 2015 17:05

Last Modified:

26 Jun 2016 01:56

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Systematic review, Meta-analysis, Research synthesis, Random effects, Fixed effect, Heterogeneity




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