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(Stroke. 1998;29:2203-2210.)
© 1998 American Heart Association, Inc.

Comments, Opinions, and Reviews

Quality of Full and Final Publications Reporting Acute Stroke Trials

A Systematic Review

Fiona J. Bath, PhD; Victoria E. Owen, BSc; Philip M. W. Bath, FRCP

From the Stroke Group, Department of Medicine, King's College School of Medicine and Dentistry, London, UK.

Correspondence to Dr F. Bath, Division of Stroke Medicine, City Hospital, Nottingham NG5 1PB, UK. E-mail fiona.bath{at}nottingham.ac.uk

Background and Purpose—Several studies have shown that the quality of reporting of trials throughout medicine is variable and often poor. We report on the quality of the final reports of randomized controlled trials (RCTs) of drug therapies assessed in acute stroke.

Methods—English-language reports published up to the end of 1996 relating to completed RCTs in acute stroke were identified from electronic searches of the Cochrane Stroke Review Group database of stroke trials and the Cochrane Controlled Trials Register (CD-ROM issue 1, 1997, of the Cochrane Library). Report quality was assessed with the 33 criteria of the CONSORT statement and 53 additional factors relevant to acute stroke or trials in general. Trial quality was also assessed with a 7-point scale.

Results—Up to 1996, 114 RCTs were published which involved 20 536 patients (median, 80; range, 16 to 1267 per trial); 39 (35.5%) of these were published in Stroke. The median total report quality was 40/86 (range, 15 to 61) for all criteria and 19/33 (range, 9 to 29) for the CONSORT criteria alone. Although adequate information was given in the introduction and discussion sections of most reports, insufficient details were given on methods, assignment of patients to treatment groups, statistical analyses, the prevalence of risk factors, and assessment of outcomes. Report quality has improved between 1956 and 1996 (Spearman correlation coefficient [r_s], 0.575; 95% confidence interval [CI], 0.439 to 0.685) and was superior in large trials (r_s=0.434; 95% CI, 0.274 to 0.571). Although report quality was related to trial quality (r_s=0.675; 95% CI, 0.563 to 0.763), it was not related to journal impact factor (r_s=0.170; 95% CI, -0.015 to 0.344). Trials with a positive outcome tended to be less well reported than those with a neutral or negative outcome (r_s=-0.192; 95% CI, -0.351 to -0.011).

Conclusions—The overall quality of study reports for parallel group RCTs in acute stroke is poor but appears to be improving with time and in parallel with an increase in trial size. Reports often lack detailed information on the methods of randomization, concealment of allocation, and statistical analysis, all factors which can, if undertaken poorly, affect trial results and validity. It is vital that future trials are adequately reported; we believe that authors should follow the CONSORT guidelines and that referees and editors should ensure this happens.

Key Words: stroke, acute • quality control • stroke management • randomized controlled trials

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