21st Century Evidence: Randomized Controlled Trials Versus Systematic Reviews and Meta-Analyses

In this issue of Critical Care Medicine, there are two systematic review and meta-analyses (SRMAs) assessing IV vitamin C therapy in patients with sepsis. Although most readers are likely familiar with using randomized clinical trials (RCTs) in clinical decisions, some may be less familiar with using SRMAs. In this foreword, we will review benefits and downsides of SRMAs and address the value of SRMAs in relation to RCTs and their respective roles in clinical decision-making.

Ultimately, SRMAs are only as good as the studies they include. The discerning clinician should review SRMAs with the same careful lens that they use to appraise traditional RCT and be aware that the quality and reproducibility of each study included in the SRMA will influence the results of the SRMA. If the SRMA meets those exacting criteria, we would suggest that a clinician should be comfortable using the results of a well-done SRMA as well as a large RCT to inform clinical care.