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. 2016 Dec 18;14(5):754–763. doi: 10.1111/iwj.12692

Poor methodological quality and reporting standards of systematic reviews in burn care management

Jason Wasiak 1,2,✉, Zephanie Tyack 3, Robert Ware 4, Nicholas Goodwin 5, Clovis M Faggion Jr 6
PMCID: PMC7949759  PMID: 27990772

ABSTRACT

The methodological and reporting quality of burn‐specific systematic reviews has not been established. The aim of this study was to evaluate the methodological quality of systematic reviews in burn care management. Computerised searches were performed in Ovid MEDLINE, Ovid EMBASE and The Cochrane Library through to February 2016 for systematic reviews relevant to burn care using medical subject and free‐text terms such as ‘burn’, ‘systematic review’ or ‘meta‐analysis’. Additional studies were identified by hand‐searching five discipline‐specific journals. Two authors independently screened papers, extracted and evaluated methodological quality using the 11‐item A Measurement Tool to Assess Systematic Reviews (AMSTAR) tool and reporting quality using the 27‐item Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) checklist. Characteristics of systematic reviews associated with methodological and reporting quality were identified. Descriptive statistics and linear regression identified features associated with improved methodological quality. A total of 60 systematic reviews met the inclusion criteria. Six of the 11 AMSTAR items reporting on ‘a priori’ design, duplicate study selection, grey literature, included/excluded studies, publication bias and conflict of interest were reported in less than 50% of the systematic reviews. Of the 27 items listed for PRISMA, 13 items reporting on introduction, methods, results and the discussion were addressed in less than 50% of systematic reviews. Multivariable analyses showed that systematic reviews associated with higher methodological or reporting quality incorporated a meta‐analysis (AMSTAR regression coefficient 2.1; 95% CI: 1.1, 3.1; PRISMA regression coefficient 6·3; 95% CI: 3·8, 8·7) were published in the Cochrane library (AMSTAR regression coefficient 2·9; 95% CI: 1·6, 4·2; PRISMA regression coefficient 6·1; 95% CI: 3·1, 9·2) and included a randomised control trial (AMSTAR regression coefficient 1·4; 95%CI: 0·4, 2·4; PRISMA regression coefficient 3·4; 95% CI: 0·9, 5·8). The methodological and reporting quality of systematic reviews in burn care requires further improvement with stricter adherence by authors to the PRISMA checklist and AMSTAR tool.

Keywords: AMSTAR, Burns, Methodological quality, PRISMA, Systematic review

Introduction

Over the last decade, there has been an exponential rise in the development and promotion of systematic reviews. Systematic reviews provide information by summarising numerous studies and combining individual study results into an overall effect of current treatment regimes, which can offer practicing clinicians an objective, comprehensive view of the research literature 1, 2. In view of the high level of evidence systematic reviews are expected to offer, the importance of methodological and reporting quality of systematic reviews has become increasingly recognised. Consequently, a number of evidence‐based initiatives have been developed to enhance review quality, with one intended result being to minimise the deleterious effects misleading results may have on clinical practice 3. One such reporting initiative is the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) statement, which is comprised of 27 items examining all aspects of the review 4. Checklists have also been developed in an attempt to assess the methodological quality of systematic reviews as distinct from the reporting of the systematic review process 5. One such checklist is A Measurement Tool to Assess Systematic Reviews (AMSTAR) that identifies and assesses important methodological characteristics of a systematic review 6. The AMSTAR tool has been shown to have good agreement, reliability, construct validity and feasibility 7.

In the burns literature, only a handful of studies have reported the methodological quality of clinical practice guidelines 8 and randomised control trials 9, 10 using appropriate tools reflecting the nature of the included studies. However, with increasing evidence suggesting that advances in burn care activity contribute to important clinical end‐points (i.e. overall survival, improvements in quality of life), explicit and precise methodological reporting of individual study quality, as well when the studies are combined in the form of a systematic review, is essential. The aim of this study was to evaluate the methodological and reporting quality of burn‐specific systematic reviews using the AMSTAR tool and PRISMA checklists.

Methods

Data source and search strategy

A structured literature search was performed in Ovid MEDLINE (1946 to February 2016), Ovid EMBASE (1974 to February 2016) and The Cochrane Library Issue 2, 2016 using medical subject heading and free‐text terms related to ‘burns’ or ‘thermal injury’ and ‘systematic review’ or ‘meta‐analysis’. The thesaurus vocabulary of each database was used to adapt the search terms. In addition, one author (JW) searched the reference lists of included studies and the discipline‐specific journals Burns, Journal of Burn Care and Research, Plastics and Reconstructive Surgery, Annals of Plastic Surgery and International Wound Journal in February 2016. The search strategy for Ovid MEDLINE is outlined in Appendix S1.

Study selection criteria and procedures

Inclusion criteria were: (i) articles of systematic review alone or systematic reviews containing meta‐analyses and (ii) systematic reviews examining therapeutic burn care interventions. For the purpose of this review, an article was considered to be a systematic review if it contained these phrases in the title or described an appropriate search strategy that documented the use of one or more search‐engine databases and a series of search terms applied to the database to retrieve potential studies for inclusion. The exclusion criteria were: (i) epidemiological, diagnostic or prognostic systematic reviews; (ii) non‐English language systematic reviews; (iii) not available in full‐text; or (iv) narrative reviews, clinical practice guidelines or evidence‐based commentaries. Two authors (JW; ZT) independently screened and reviewed the titles and abstracts against the inclusion criteria. Full‐text articles were retrieved and reviewed independently in duplicate by two authors (JW; ZT) for potentially eligible studies. Discrepancies were resolved by discussion and consulting with other co‐authors (NG; CF).

Assessment of reporting quality

Eligible systematic reviews were assessed against each item in the PRISMA statement, which is an internationally recognised guideline used for quality reporting of reviews 4. The PRISMA statement includes a checklist pertaining to each section of the systematic review, including title, abstract, introduction, methods, results, discussion, conclusion and funding. Each PRISMA item is judged with a ‘yes’, ‘no’, or ‘don't know’ response. A ‘yes’ response means that the item was fulfilled; a ‘no’ response means that the item was not fulfilled; and a ‘don't know’ response means that because of incomplete reporting or unclear language, it is inconclusive as to whether the item was fulfilled. A score of one was assigned to ‘yes’, and a score of zero was assigned to ‘no’ or ‘don't know’, resulting in an overall potential score of 27. Two authors (JW; NG) independently assessed the identified systematic reviews, with any disagreement resolved by discussion with a third author (ZT).

Assessment of methodological quality

The methodological quality of systematic reviews was assessed using the AMSTAR tool, which is a reliable and valid instrument available for this purpose 7. The AMSTAR tool is an 11‐item questionnaire consisting of questions regarding the appropriate usage of methods and consideration of bias. Each question is scored with a ‘yes,’ ‘no’, and ‘can't answer/not applicable’ response. A ‘yes’ response means that the item is fulfilled; a ‘no’ response means that the item is not fulfilled; a ‘can't answer/not applicable’ response means that it is inconclusive as to whether the item was fulfilled; and a ‘not applicable’ response means that the item is not relevant for the type of paper. For example, if the systematic review did not perform a meta‐analysis, a 'not applicable' response would be selected for several items 2, 11. A score of one was assigned to ‘yes’, and a score of zero was assigned to ‘no’ or ‘can't answer/not applicable’, resulting in an overall potential score of 11. Disagreements were resolved by discussion.

Data extraction and synthesis

One author (JW) extracted information using a data extraction sheet developed by two authors (JW; CF) that related to the following variables: (i) number and type of included studies, (ii) inclusion of a meta‐analysis, (iii) number of randomised control trials (RCT) identified, (iv) area of clinical burn‐care practice, (v) type of burn care interventions, (vi) corresponding author's country of residence, (vii) year of publication (viii) journal name; and (ix) impact factor (IF) according to the Science Citation Index 12 Two authors (NG; JW) pilot‐tested the AMSTAR tool on five systematic reviews to standardise use and eliminate inconsistency before three authors (JW; NG; ZT) used the PRISMA statement and AMSTAR tool to extract SR content, with discrepancies resolved by discussion between authors. In addition, two authors (JW; ZT) independently collapsed the systematic review into five topic areas (scar management, wound care, rehabilitation/injury prevention, pain management and acute care practices).

Data analysis

Descriptive statistics are presented as mean and standard deviation (SD) for continuous variables and as frequency (percentage) for categorical variables. Frequency of each AMSTAR and PRISMA item was calculated. We investigated the association between study characteristics (inclusion of a meta‐analysis, author origin, journal type, study category, study intervention, number of studies included, whether an RCT was identified, impact factor and author number) and systematic review quality as assessed using the PRISMA and AMSTAR criteria using linear regression. The total score of the scale was entered as the outcome variable, and the characteristic of interest was entered as the main effect. Multivariable models were adjusted for variables with a significant association with the total scores in univariable regression models. Statistical significance was defined as P < 0·05. Analyses were conducted using Stata statistical software v13.1 (StataCorp, College Station, TX)

Results

The initial search of databases identified 579 studies, whilst hand searching captured an additional 21 studies to provide a total of 600 studies for potential inclusion. Independent scrutiny of the titles and abstracts by two authors (JW; ZT) identified 119 potentially relevant articles. Of those, we excluded an additional 59 studies because they failed to meet the methodological definition of systematic review as per our inclusion criteria 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79. Therefore, a total of 60 systematic reviews formed the basis of this study 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132, 133, 134, 135, 136, 137, 138

Study characteristics

The characteristics of the 60 systematic reviews are shown in Table 1. There were 30 (50%) systematic reviews containing meta‐analyses. A total of 26 (43%) systematic reviews included 10 or more studies, and 38 (60%) systematic reviews included at least one study with an RCT design. When considering the corresponding author's place of residence, 43% (n = 26) came from Asia Pacific, followed closely by Europe (25%, n = 15) and the United States (including Canada) (22%, n = 13).

Table 1.

Characteristics and quality scores assessed using the AMSTAR and PRISMA checklists

Items n (%) AMSTAR Mean (SD)* PRISMA Mean (SD)*
Type
Systematic review only 30 3·5 (2·0) 9·0 (4·9)
Systematic review including meta‐analysis 30 6·9 (2·3) 17·4 (5·0)
Author origin
USA/Canada 13 3·5 (2·3) 8·8 (4·9)
Europe including UK 15 5·7 (3·3) 13·7 (8·1)
Asia‐Pacific 26 5·9 (2·2) 15·3 (4·8)
Other  6 4·3 (3·1) 12·2 (8·1)
Journal
Journal of Burn Care and Research/Burns 32 4·5 (2·4) 10·9 (5·9)
The Cochrane Library 11 8·7 (0·8) 20·4 (3·0)
General/specialist surgical journals  4 4·3 (3·8) 11·3 (7·3)
General/specialist medical journals 13 4·2 (2·0) 13·5 (5·8)
Study category
Scar  5 4·8 (3·1) 10·6 (5·9)
Wound care 22 5·7 (2·8) 14·4 (6·9)
Rehabilitation and injury prevention  9 5·8 (3·1) 14·1 (6·1)
Pain management  5 4·0 (1·4) 11·0 (6·3)
Acute care practices 19 4·7 (2·7) 12·6 (6·7)
Study intervention
Pharmacology  9 6·0 (2·3) 15·3 (6·3)
Scar treatments  4 4·0 (2·9) 8·5 (5·8)
Acute care practices 44 5·2 (2·8) 13·3 (6·6)
Rehabilitation  3 4·7 (3·1) 11·3 (5·0)
Number of studies per review
5 or less 16 6·3 (2·6) 15·3 (5·4)
6–10 16 5·1 (2·4) 13·4 (6·1)
10+ 26 4·8 (2·9) 12·2 (7·3)
Can't answer  2 2·5 (0·7) 7·5 (3·5)
RCT identified
No 18 3·9 (2·9) 9·6 (5·8)
Yes 38 6·1 (2·3) 15·6 (5·9)
Can't answer  4 2·2 (1·0) 6·8 (2·5)
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RCT, randomised controlled trial; SD, standard deviation; UK, United Kingdom; USA, United States of America.

*

Total score (AMSTAR maximum total score = 11; PRISMA maximum total score = 27)

Methodological quality (AMSTAR)

The percentage of items appropriately addressed for the AMSTAR tool is reported in Table 2. The mean overall reporting quality score for a systematic review containing a meta‐analysis was 6·9 (SD = 2·3). The highest mean score was observed in The Cochrane Library (mean = 8·7, SD = 0·8), whilst the mean score reported in burn‐specific journals was lower (mean = 4·5, SD = 2·4). Just over 77% of systematic reviews reported the use of two or more databases and a series of search terms to locate their included studies (Q3), whilst 95% of systematic reviews documented the characteristics of included studies using variations of the PICO (patient, intervention, comparator, outcome) format (Q6). In addition, 68% of systematic reviews reported on methodological quality using a variety of tools (Q7), whereas 63% used the scientific quality of the included studies to appropriately formulate conclusions (Q8).

Table 2.

Frequency distribution of AMSTAR items for the total number of systematic reviews (n = 60)

AMSTAR item n (%)
No Yes
1. A priori study design stated 46 (77) 14 (23)
2. Duplicate study selection and data extraction 31 (52) 29 (48)
3. Comprehensive literature search 14 (23) 46 (77)
4. Status of publication used as inclusion criteria 46 (77) 14 (23)
5. List of studies provided 34 (57) 26 (43)
6. Characteristics of included studies provided 3 (5) 57 (95)
7. Scientific quality of included studies provided 19 (32) 41 (68)
8. Scientific quality used to formulate conclusions 22 (37) 38 (63)
9. Appropriate methods used to combine studies 26 (43) 34 (57)
10. Likelihood of publication bias assessed 48 (80) 12 (20)
11. Conflict of interest stated 60 (100) 0 (0)
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AMSTAR, Assessment of Multiple Systematic Reviews; n, number.

The remaining six items listed (Q1, 2, 4, 5, 10–11) were reported in less than 50% of systematic reviews. For example, an ‘a priori’ design (Q1) was included in 23% of systematic reviews, whilst only 20% addressed publication bias (Q10). No systematic review fulfilled the criteria for reporting their source of funding or the funding of included trials (Q11). Systematic reviews that fell under the study categories of scar or acute care practices had the lowest mean methodological quality (mean = 4·8 and 4·7, respectively).

Reporting quality (PRISMA)

The percentage of items reported for the PRISMA checklist is listed in Table 3. The mean overall reporting quality score for a systematic review containing a meta‐analysis was 17·4 (SD = 5), with the highest score observed in The Cochrane Library (20·4, SD = 3·0) and the lowest scores found in burn‐specific journals (10·9, SD = 5·9). Of the 27 items listed for PRISMA, 14 items were addressed in less than 50% of systematic reviews. These items included: study objectives (Q4), review registration (Q5), eligibility criteria (Q6), information sources used (Q7), search strategy (Q8), risk of bias (Q12; Q15; Q22), summary estimates along with additional analysis used during meta‐analysis (Q13; Q16; Q23), overall summary of evidence (Q24), study limitations (Q25) and funding (Q27). The remaining 12 PRISMA items were reported satisfactorily, with most systematic reviews supporting a structured summary (Q2), a study rationale (Q3) and clearly defined study conclusions (Q26). Systematic reviews exploring scar or pain management also had the lowest mean reporting quality (mean = 10·6 and 11, respectively), whilst systematic reviews of wound care and rehabilitation and injury prevention had the highest mean reporting quality (mean = 14·4 and 14·1, respectively) (Table 1). Scar intervention systematic reviews had the lowest reporting quality, and pharmacology intervention systematic reviews had the highest reporting quality (mean = 8·5 and 15·3, respectively).

Table 3.

Frequency distribution of PRISMA items for the total number of systematic reviews (n = 60)

PRISMA item n (%)
No Yes
1. Title 14 (23) 46 (77)
2. Structured summary 1 (2) 59 (98)
3. Rationale 3 (5) 57 (95)
4. Objectives 39 (65) 21 (35)
5. Protocol and registration 54 (90)  6 (10)
6. Eligibility criteria 30 (50) 30 (50)
7. Information sources 42 (70) 18 (30)
8. Search 38 (63) 22 (37)
9. Study selection (methods) 26 (43) 34 (57)
10. Data collection process 25 (42) 35 (58)
11. Data items 26 (43) 34 (57)
12. Risk of bias in individual studies 30 (50) 30 (50)
13. Summary measures 31 (52) 29 (48)
14. Synthesis of results (methods) 29 (48) 31 (52)
15. Risk of bias across studies (methods) 43 (72) 17 (28)
16. Additional analyses (methods) 49 (82) 11 (18)
17. Study selection (results) 26 (43) 34 (57)
18. Study characteristics 13 (22) 47 (78)
19. Risk of bias within studies 29 (48) 31 (52)
20. Results of individual studies 24 (40) 36 (60)
21. Synthesis of results (results) 39 (65) 21 (35)
22. Risk of bias across studies (results) 47 (78) 13 (22)
23. Additional analysis (results) 55 (92) 5 (8)
24. Summary of evidence 30 (50) 30 (50)
25. Limitations 33 (55) 27 (45)
26. Conclusions 11 (18) 49 (82)
27. Funding 41 (68) 19 (32)
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n = number; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta‐analyses.

AMSTAR regression analysis

Table 4 shows the univariable and multivariable relationship between study demographics on the AMSTAR score. In both models, our results showed better AMSTAR scores when the systematic review incorporated a meta‐analysis, was published in The Cochrane Library and included one or more studies with an RCT design.

Table 4.

Univariable and multivariable linear regression for the effect of conducting a meta‐analysis, author origin, journal, study category, study intervention, number of studies per review and RCT identified on AMSTAR scores

Variable Category/unit AMSTAR univariate regression AMSTAR multivariable regression
Mean Diff. 95% CI P value Mean Diff. 95% CI P value
Conduct meta‐analysis No Reference Reference
Yes 3·4 2·3, 4·5 <0·001 2·1 1·1, 3·1 <0·001
Authors residence Asia‐Pacific Reference Reference
USA/Canada −2·5 −4·2, −0·7 0·008 −1·0 −2·3, 0·3 0·13
Europe incl. UK −0·2 −1·9, 1·5 0·82 0·4 −0·7, 1·5 0·49
Other −1·6 −4·0, 0·8 0·19 −0·7 −2·3, 0·9 0·38
Journal type JBCR/Burns Reference Reference
The Cochrane Library 4·2 2·7, 5·8 <0·001 2·9 1·6, 4·2 <0·001
General/specialist surgical −0·3 −2·6, 2·1 0·83 0·2 −1·6, 2·0 0·83
General/specialist medical −0·3 −1·8, 1·1 0·64 −0·5 −1·7, 0·7 0·42
Study category Wound care Reference Reference
Scar management −0·9 −3·7, 1·8 0·50 1·1 −0·9, 3·1 0·28
Rehabilitation and injury prevention 0·1 −2·1, 2·2 0·96 −0·9 −2·2, 0·5 0·20
Pain management −1·7 −4·5, 1·0 0·21 −0·1 −1·8, 1·7 0·93
Acute care practices −1·0 −2·8, 0·7 0·24 −0·4 −1·5, 0·7 0·45
Study intervention Acute care practices Reference Reference
Scar treatments −1·2 −4·1, 1·7 0·43 0·7 −1·2, 2·6 0·47
Pharmacology 0·8 −1·2, 2·9 0·41 0·4 −0·9, 1·7 0·55
Rehabilitation −0·5 −3·8, 2·8 0·77 −0·6 −2·7, 1·5 0·57
Number of studies per review 5 or less Reference Reference
6–10 −1·1 −3·0, 0·8 0·24 0·3 −1·1, 1·7 0·69
10+ −1·5 −3·2, 0·2 0·09 −0·3 −1·5, 0·8 0·57
Can't answer −3·8 −7·8, 0·3 0·07 −0·7 −3·5, 2·1 0·62
RCT identified No Reference Reference
Yes 2·2 0·8, 3·6 0·003 1·4 0·4, 2·4 0·009
Can't answer −1·6 −4·4, 1·1 0·24 Reference −0·1 (−2·1, 1·8) 0.88
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AMSTAR, Assessment of Multiple Systematic Reviews; CI, confidence interval; JBCR, Journal of Burn Care and Research; Mean Diff, mean difference; RCT, randomised controlled trial; UK, United Kingdom; USA, United States of America.

PRISMA regression analysis

Table 5 shows the univariable and multivariable relationship between study demographics on the AMSTAR score. In both models, our results showed better PRISMA scores when the systematic review incorporated a meta‐analysis, was published in The Cochrane Library and included one or more studies with an RCT design.

Table 5.

Univariable and multivariable linear regression for the effect of conducting a meta‐analysis, author origin, journal, study category, study intervention, number of studies per review and RCT identified on PRISMA scores

Variable Category/unit PRISMA univariable regression PRISMA multivariable regression
Mean Diff. 95% CI P value Mean Diff. 95% CI P value
Conduct meta‐analysis No Reference Reference
Yes  8·4   5·8, 11·0 <0·001 6·3  3·8, 8·7 <0·001 
Authors residence Asia Pacific Reference Reference
USA/Canada −6·6 −10·7, −2·4  0·003 −2·5  −5·6, 0·7 0·12
Europe incl. UK −1·6 −5·6, 2·4 0·42 0·2 −2·5, 2·9 0·88
Other −3·2 −8·7, 2·4 0·26 −1·9  −5·7, 1·9 0·33
Journal type JBCR/Burns Reference Reference
The Cochrane Library  9·5   5·6, 13·4 <0·001  6·1  3·1, 9·2 <0·001 
General/specialist surgical  0·4 −5·5, 6·3 0·90 1·0 −3·4, 5·2 0·65
General/specialist medical  2·6 −1·0, 6·3 0·16 2·6 −0·4, 5·6 0·09
Study category Wound care Reference Reference
Scar management −3·8 −10·4, 2·7  0·25 −0·1  −5·1, 4·8 0·96
Rehabilitation and injury prevention −0·3 −5·5, 4·9 0·91 −2·3  −5·6, 1·0 0·17
Pain management −3·4 −10·0, 3·1  0·30 −0·7  −5·1, 3·7 0·75
Acute care practices −1·8 −5·9, 2·4 0·39 −0·8  −3·5, 1·9 0·56
Study intervention Acute care practices Reference Reference
Scar treatments −4·8 −11·6, 2·0  0·16 −0·3  −5·0, 4·3 0·89
Pharmacology  2·0 −2·7, 6·8 0·40 0·4 −2·8, 3·5 0·82
Rehabilitation −2·0 −9·7, 5·8 0·61 −1·9  −7·1, 3·2 0·46
Number of studies per review 5 or less Reference Reference
6–10 −1·9 −6·4, 2·7 0·41 1·6 −1·8, 5·0 0·35
10+ or more −3·1 −7·2, 1·0 0·13 −0·1  −2·9, 2·7 0·94
Can't answer −7·8 −17·5, 1·9  0·11 −0·6  −7·2, 6·1 0·87
RCT identified No Reference Reference
Yes  6·0  2·8, 9·3 <0·001 3·4  0·9, 5·8  0·009
Can't answer −2·8 −9·1, 3·5 0·38 1·5 −3·3, 6·3 0·53
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CI, confidence interval; JBCR, Journal of Burn Care and Research; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta‐Analyses; RCT, randomised controlled trial; UK, United Kingdom; USA, United States of America.

Discussion

Summary of findings

The 60 identified reviews included a series of methodological and reporting quality shortcomings. Overall, 7 of the 11 AMSTAR items and 14 of the 27 PRISMA items were reported in less than 50% of systematic reviews. In addition, we found an improvement in total AMSTAR and PRISMA scores when the systematic reviews incorporated a meta‐analysis, were published in The Cochrane Library and included one or more studies with an RCT design.

Agreements and disagreements with other reviews

This review builds on the only ever‐published study looking at the quality assessment of systematic reviews in the burns literature 139. The study by Campbell investigated the adherence to reporting standards and methodology quality using the PRISMA checklist and AMSTAR tool in 44 burn‐specific systematic reviews. Like our recent findings, they observed overall quality to be low, with poor reporting noted in question items 1, 10 and 11 of AMSTAR and question items 5, 15 and 16 of the PRISMA checklist. In addition, they also noted that systematic reviews published in The Cochrane Library had better PRISMA and AMSTAR scores when compared to other journals. However, we observed that the study included a smaller sample size, searched the literature using an arbitrary date (i.e. the 2009 publication date of the PRISMA checklist although the AMSTAR tool was first published in 2007) and reported interpreting aspects of the PRISMA checklist without describing any pilot‐testing procedures to standardise use or eliminate inconsistencies.

Study limitations

This study had a number of limitations. Firstly, our study was restricted to systematic reviews examining therapeutic burn care interventions only, thus excluding a large number of reviews (n = 59) that may have produced a different response. Secondly, we were restricted to electronic databases, which may not have been representative of all indexed studies. Other medical databases, national clearinghouse and guideline sites were not systematically searched. Thirdly, just over 63% of systematic reviews included an RCT, which suggested our assessment of non‐randomised studies (NRS) using tools designed for reviews of RCT were ill advised. However, we noted a study by a group of authors who described how they applied the AMSTAR tool to a systematic review of risk factors in a large cohort of NRS 140. In this instance, AMSTAR showed good psychometric properties when applied to systematic reviews of NRS. Lastly, it appeared to be challenging for some AMSTAR items to capture the methodological quality of the systematic review. In fact, some AMSTAR items appear to be more related to the quality of reporting than methodological quality 141. A further development in the evaluation of methodologies of systematic review would be the focus on the evaluation of the domains of risk of bias described in systematic reviews 142.

Recommendations to improve systematic review practices

Our findings, along with the limited evidence base informed by the number of studies found within this field, would suggest the need for ongoing education in clinical research and evidence‐based medicine. However, there has also been a significant rise in the development of checklists, reporting guidelines, methodological tools, study registries, data repositories, clinical websites, evidence‐based centres and research organisations to help minimise this problem. Alongside this evidence armamentarium has been a suite of practical suggestions to help improve the quality of systematic reviews. Some of these suggestions have included more research methodology training, adhering to methodological and reporting quality assessment tools when designing a systematic review, engaging with experts in the field of systematic review methodology and keeping journal editors and reviewers more accountable to higher reporting standards 143

Whilst these suggestions appear practical, Glasziou 144 reports that unless research is framed around a reporting structure, much of the time and resources invested in its conduct is simply wasted. Also offering a series of options for methodological improvements during the various stages of publications (i.e. pre‐submission, reviewing, publication or post‐publication stage), Glasziou 144 recommends that only real change in reporting will take place when research regulations and rewards are aligned to better and more complete publication targets. Whilst this change may take some time, the best we can do right now is remind ourselves that the best systematic reviews answer all the statements and items described in the PRISMA checklist and AMSTAR tool.

Conclusion

The results of this study demonstrate that even with immediate access to methodological and reporting quality checklists and tool kits, approximately half of the systematic reviews did not address half of the the PRISMA checklist and AMSTAR tool items (13/27 statements and 6/11 items, respectively). However, systematic reviews that contained a meta‐analysis, were published in The Cochrane Library and included one or more studies with an RCT design were superior in their methodological and reporting quality.

Supporting information

Appendix S1. Search strategy.

Click here for additional data file. (39KB, docx)

Wasiak, J ., Tyack, Z ., Ware, R ., Goodwin, N ., Faggion, CM Jr . (2017). Poor methodological quality and reporting standards of systematic reviews in burn care management. International Wound Journal, 14:754–763. doi: 10.1111/iwj.12692

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Appendix S1. Search strategy.

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