Major mistakes or errors in the use of trial sequential analysis in systematic reviews or meta-analyses – the METSA systematic review

Systematic reviews and meta-analyses are crucial for clinical practice and health policy, but methodological errors, especially in trial sequential analysis (TSA), are concerning. This study assesses the reporting quality of TSA in systematic reviews, focusing on protocol adherence, transparency, and interpretation of results. The research aims to enhance the transparency of TSA in systematic reviews to aid clinical practitioners and decision-makers in unbiased decision-making.

• 1
  Only 50% of systematic reviews planned the trial sequential analysis in their protocols, indicating a lack of prospective planning.
• 2
  Key parameters for analyses on dichotomous outcomes, such as the proportion of events in the control group, relative risk reduction, alpha, beta, and heterogeneity, were frequently missing.
• 3
  A significant percentage of trial sequential analyses lacked transparency, with 38% categorized as 'very poor' and 28% as 'poor' in overall transparency.