Letter to the Editor
Some flaws that could change the effect sizes and limit the extrapolation of these results
Alguns pontos fracos que podem alterar os tamanhos dos efeitos e limitar a extrapolação desses resultados
Carlos Alberto Velasco-Benítez
, Herney Andrés García-Perdomo
Corresponding author
Universidad del Valle, Cali, Colombia
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however, we found that authors misclassified four out of the nine articles included in this systematic review: Castillejo et al.,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> actually used functional constipation (FC) criteria according to Rome II; Mozaffarpur et al.,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> included patients classified using both Rome III criteria and the Paris Consensus on Childhood Constipation Terminology Criteria; Loening-Baucke<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> defined FC according to the Medical Position Statement of the North American Society for Pediatric Gastroenterology and Nutrition in 1999; finally, Kokke et al.,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> included patients according to Loening-Baucke.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> This unappropriated inclusion of studies might have led to different effect sizes due to clinical heterogeneity. The authors should have stated that they were going to include different Rome Criteria and afterwards, they should have conducted a sensibility or a subgroup analysis to identify the alteration in effect sizes.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Regarding the methods used to perform this systematic review, we have found some flaws in the following issues<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0020" class="elsevierStylePara elsevierViewall">Protocols for systematic reviews and meta-analysis must be published in PROSPERO before performing the entire process and the publication of the final manuscript.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0025" class="elsevierStylePara elsevierViewall">The search strategy must be based on patient (population), intervention, and study design according to different manuscripts. This one was based on patient, outcome, and study design, which might lead to selection bias.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0030" class="elsevierStylePara elsevierViewall">Using two tools for assessing bias is unnecessary (RoB Cochrane tool and Jadad score). If the authors wanted to perform another analysis, assessing the quality of evidence using the GRADE tool would have been important and interesting.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0035" class="elsevierStylePara elsevierViewall">There was no appropriate description of the strategy to identify non-published literature, for example, Google Scholar, Open Grey database, clinical trials registries, and conferences, among others. This might have created publication bias.</p></li></ul></p><p id="par0040" class="elsevierStylePara elsevierViewall">Consequently, we suggest caution in the use of the findings when extrapolating results to clinical practice.</p><span id="sec0021" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0041">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0021" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Velasco-Benítez CA, García-Perdomo HA. Some flaws that could change the effect sizes and limit the extrapolation of these results. J Pediatr (Rio J). 2019;95:374–5.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of fibers in childhood constipation treatment: systematic review with meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Piccoli de Mello" 1 => "D.A. Eifer" 2 => "E. 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Salas-Salvado" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2006-0090" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2006" "volumen" => "118" "paginaInicial" => "e641" "paginaFinal" => "e648" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16950955" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of cassia fistula emulsion on pediatric functional constipation in comparison with mineral oil: a randomized, clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Mozaffarpur" 1 => "M. Naseri" 2 => "M. Esmaeilidooki" 3 => "M. Kamalinejad" 4 => "F.A. Bijani" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "DARU J Pharm Sci" "fecha" => "2012" "volumen" => "20" "paginaInicial" => "83" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fiber (glucomannan) is beneficial in the treatment of childhood constipation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Loening-Baucke" 1 => "E. Miele" 2 => "F.A. Staiano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2004" "volumen" => "113" "paginaInicial" => "e259" "paginaFinal" => "e264" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14993586" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A dietary fiber mixture <span class="elsevierStyleItalic">versus</span> lactulose in the treatment of childhood constipation: a double-blind randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F. Kokke" 1 => "P. Scholtens" 2 => "M. Alles" 3 => "T. Decates" 4 => "T. Fiselier" 5 => "F.J. 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| 2021 January | 6 | 9 | 15 |
| 2020 December | 9 | 11 | 20 |
| 2020 November | 3 | 9 | 12 |
| 2020 October | 3 | 8 | 11 |
| 2020 September | 12 | 13 | 25 |
| 2020 August | 2 | 1 | 3 |
| 2020 July | 6 | 6 | 12 |
| 2020 June | 7 | 3 | 10 |
| 2020 May | 4 | 3 | 7 |
| 2020 April | 4 | 6 | 10 |
| 2020 March | 3 | 2 | 5 |
| 2020 February | 10 | 10 | 20 |
| 2020 January | 9 | 24 | 33 |
| 2019 December | 7 | 10 | 17 |
| 2019 November | 5 | 7 | 12 |
| 2019 October | 11 | 9 | 20 |
| 2019 September | 9 | 11 | 20 |
| 2019 August | 12 | 11 | 23 |
| 2019 July | 23 | 12 | 35 |
| 2019 June | 12 | 13 | 25 |
| 2019 May | 3 | 4 | 7 |
| 2019 April | 12 | 8 | 20 |
| 2019 March | 4 | 12 | 16 |
| 2019 February | 5 | 3 | 8 |
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