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Bias because of selective inclusion and reporting of outcomes and analyses in systematic reviews of randomized trials of healthcare interventions

Background A systematic review summarizes the results of available carefully designed healthcare studies (controlled trials) and provides a high level of evidence on the effectiveness of healthcare interventions (consumers.cochrane.org). It is considered a cornerstone of evidencebased practice. Findings help clinicians with up-to-date information and aid in decision-making, identify gaps in knowledge, and provide recommendations for future research. However, practices such as selective publication of studies and reporting of a subset of outcomes may affect the validity of systematic reviews. In an updated systematic review by Dwan et al., there remains a strong evidence of an association between significant results and publication; studies that report positive or significant results are more likely to be published and outcomes that are statistically significant have higher odds of being fully reported. Selective reporting can include discrepant outcome reporting (e.g., adding a new outcome or omitting a protocoldefined outcome). Concerns of bias and misrepresentation of available evidence may arise. Available reporting guidelines [i.e., Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane’s] provide specific recommendations on these issues, such as PRISMA’s advice to clearly indicate in the abstract the protocol-defined, prespecified importance of each outcome regardless of results. PRISMA further cautions to not only report outcomes with statistically or clinically significant results. Also, for each meta-analysis done, include confidence intervals and measures of consistency. From a nursing perspective, selective inclusion and reporting of outcomes has significant implications. This even becomes more critical for nurses at the bedside who rely on the