Systematic review: better or (otherwise) misleading for clinical decision?

Abstract

Systematic review is a method to combine multiple sources of evidence through an explicit and reproducible way of
literature search and critical appraisal of the quality of included studies, with or without mathematical methods to
synthesis these information. Since this method was first introduced more than centuries ago, systematic review has
been increasingly popular and widely used particularly in the area of medicine. Systematic review is often very
useful to physicians to help supporting the clinical decision making and significantly reducing their time to seek for
appropriate evidence. However, despite its reproducible and systematic steps to substantially minimize the presence
of biases, physicians should still be aware that systematic review is not completely biases resistant. Inclusion of
poor quality studies, heterogeneity, and publication or other reporting biases are commonly evident in systematic
review that may hinder the quality of the conclusion. This review summarizes the core principals of systematic
review and its potential biases, and discusses when the systematic review is useful or needing careful attention.
Key words: treatment-scientific evidence- meta-analysis- critical appraisal-outcomes