This review compared endovascular repair (EVR) with open repair (OR) for blunt thoracic aortic injury. The authors appeared to conclude that the review provided better evidence for EVR, but acknowledged the limitations arising from non-randomised evidence. A limited search, lack of a validity assessment and poor reporting of the review made it difficult to determine the reliability of their conclusion.

To compare endovascular repair (EVR) versus open repair (OR) for blunt thoracic aortic injury (BTAI).

MEDLINE was searched from January 1966 to December 2007. Search terms were reported. References of identified articles and reviews and commentaries were also checked.

Studies that compared EVR with OR in patients with BTAI and reported mortality were eligible for inclusion in the review.

Patients in included studies had mean ages ranging from 26 to 59 where reported. Injury severity scores ranged from 32 to 53.2 where reported.

The authors stated neither how papers were selected for the review nor how many reviewers performed the selection.

The authors did not state that they assessed validity.

Data on mortality were extracted and used to calculate odds ratios (ORs) with 95% confidence intervals (CIs). The authors stated neither how the data were extracted for the review nor how many reviewers performed the data extraction.

A random-effects meta-analysis was used to calculate a pooled OR with 95% CI for mortality. Sensitivity analyses were used to assess the contribution of each study to the pooled estimate. A sub-group analysis of studies with similar pre-operative variables in each group was also conducted. It appeared that statistical heterogeneity was assessed using the χ² and I² statistics. Publication bias was assessed by a funnel plot and rank-correlation test.

Seventeen studies (N = 565) were included in the review. All were non-randomised and retrospective.

There was statistically significant lower mortality in patients treated with EVR (8.1 per cent) compared to OR (20.8 per cent), pooled OR 0.43 (95% CI: 0.25, 0.76, p < 0.01, 17 RCTs). There was no evidence of statistical heterogeneity. Sensitivity analyses did not significantly alter the findings; this was also the case with a sub-group analysis of studies with similar pre-operative variables. No significant publication bias was detected.

The authors appeared to conclude that the review provided better evidence than was previously extant for the use of EVR rather than OR for BTAI, but acknowledged the limitations arising from reliance on non-randomised evidence.

The review question and inclusion criteria were clear. The authors searched only one database, which increased the chances that some relevant studies were not included in the review, although their assessment of publication bias found no evidence that this was present. The authors did not report using methods designed to reduce reviewer bias and error at any stage of the review. No assessment of study validity was reported, which made it difficult to assess the reliability of the evidence and conclusions based upon that evidence. The use of meta-analysis appeared appropriate as did the assessment of statistical heterogeneity. However, the limited reporting of study details made it difficult to assess the clinical homogeneity of the included studies. The authors' conclusions acknowledged some limitations of the evidence, but the lack of a validity assessment, the limited nature of the search and poor reporting of review methodology made it difficult to determine their reliability.

The authors did not state any implications for practice or further research.

Not stated.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.