Extent and handling of missing dichotomous outcome data for participants in 672 trials included in 100 Cochrane and non-Cochrane systematic reviews

Article type
Authors
Kahale LA1, Diab B1, Mustafa R2, Busse JW3, Agarwal A3, Waziry R1, Li L4, Lopes LC5, Koujanian S6, Dakik A1, Chang Y3, Guyatt GH3, Akl EA1
1American University of Beirut, Lebanon
2University of Missouri-Kansas City, USA
3McMaster University, Canada
4Sichuan University, China
5University of Sorocaba, Brazil
6Lebanese American University, Lebanon
Abstract
Background: Reports of randomized clinical trials (RCTs) do not always specify whether participants belonging to certain categories (e.g. those who withdraw consent, non-compliers) were followed-up for the outcome(s) of interest or not (i.e. missing participant data (MPD)). Systematic reviewers may, therefore, have to make assumptions on whether data from these participants is missing.
Objectives: To describe characteristics, reporting and handling of categories of participants that could be potentially counted as having MPD in RCTs included in Cochrane and non-Cochrane systematic reviews (SRs).
Methods: We selected a random sample of 100 Cochrane and non-Cochrane SRs published in 2012. Eligible SRs reported a group-level meta-analysis of a patient-important dichotomous efficacy outcome, with a statistically significant effect estimate. Ten reviewers, working in pairs, independently extracted data from the RCTs included in eligible meta-analyses. We focused on 10 categories that could be potentially counted as MPD: 'participants deemed ineligible after randomization', 'did not receive any treatment', 'withdrew consent', 'outcome not assessable', 'explained and unexplained lost to follow-up', 'dead', 'experienced adverse events', 'non-compliant', 'discontinued prematurely', and 'cross-over'. We specifically assessed: 1) the number of participants in those categories; 2) whether trialists explicitly reported on the follow-up status of those participants; and 3) how trialists handled those participants in their analysis.
Results: We included a total of 672 RCTs included in 100 eligible Cochrane and non-Cochrane SRs. We are in the process of data abstraction. We will present the findings of the study at the Colloquium.
Conclusions: Results will inform a better understanding of trial reporting on the follow-up, and handling of categories with potentially missing outcome data, an issue of importance for systematic reviewers and for standards of trial reporting.