Contrast Media: Safety Issues and ESUR Guidelines by Peter Aspelin, Marie France Bellin, Jarl å. Jakobsen, Judith

By Peter Aspelin, Marie France Bellin, Jarl å. Jakobsen, Judith A. W. Webb (auth.), Henrik S. Thomsen MD, Judith A. W. Webb MD, FRCP, FRCR (eds.)

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By Peter Aspelin, Marie France Bellin, Jarl å. Jakobsen, Judith A. W. Webb (auth.), Henrik S. Thomsen MD, Judith A. W. Webb MD, FRCP, FRCR (eds.)

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It is also all too common to retrieve only a few studies on a given clinical topic from the literature, or to find studies of such low quality that including or even discussing them in the setting of a systematic review may be misleading. This drawback is particularly associated with small study bias, which is a major threat to the validity of meta-analysis (Egger et al. 2001). Especially when datasets are large, small primary studies are more likely to be reported, published and quoted if their results are significant.

This applies particularly to the research evidence, which has now accumulated on acetylcysteine for the prevention of CIN (BiondiZoccai et al. 2006), but also to other commonly prescribed agents such as contrast media. 6 Conflicts of Interest and Funding Issues Another major threat to the validity of a systematic review, as to any other research project, depends on conflicts of interest and how studies are funded. It is well known that reviewers with underlying financial conflicts of interest are more likely to draw conclusions that favor an intervention, which benefits the source of any financial gain (Barnes and Bero 1998).

15% (Ansell et al. 1980; Witten et al. 1973). Mortality with the ionic agents is in the range 1 in 14,000 to 1 in 169,000 (Shehadi 1975; Katayama et al. 1990), with 1 in 75,000 an often quoted figure (Hartman et al. 1982). With the newer low-osmolality nonionic agents, the reaction rates are lower, by a factor of approximately 4–5 times (Katayama et al.

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