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To the Editor: Dr van Nieuwenhoven and colleagues¹ attempted to assess the relationship between trial quality and estimates of treatment for selective digestive decontamination (SDD) of critically ill patients.

Despite their claims about the importance of using rigorous methods of assessment, however, the authors fall short of this standard in several aspects of their analysis, including identification of studies, choice of the instrument for assessing trial quality, and presentation and interpretation of the results.

The description of the study search is misleading, since it leaves the impression that only randomized controlled trials (RCTs) were included in the study. This is not true, however, as references 17, 18, 19, 21, and 29 are not randomized studies.²

van Nieuwenhoven et al did not report the reliability and validity of the scale used for the quality assessment, to which a new item was added for this study. Moreover, the cutoff point used in . . . [Full Text of this Article]

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Relationship Between Methodological Trial Quality and the Effects of Selective Digestive Decontamination on Pneumonia and Mortality in Critically Ill Patients
Christianne A. van Nieuwenhoven, Erik Buskens, Frank H. van Tiel, and Marc J. M. Bonten
JAMA. 2001;286(3):335-340.
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