BACKGROUND Evidence-Based Medicine is built on the premise that clinicians can be more confident when their decisions are grounded in high-quality evidence. Furthermore, evidence from studies involving patient-oriented outcomes is preferred when making decisions about tests or treatments. Ideally, the findings of relevant and valid trials should be stable over time, that is, unlikely to be reversed in subsequent research. OBJECTIVE To evaluate the stability of evidence from trials relevant to primary healthcare and to identify study characteristics associated with their reversal. METHODS We studied synopses of randomized controlled trials (RCTs) published from 2002 to 2005 as "Daily POEMs" (Patient Oriented Evidence that Matters). The initial evidence (E1) from these POEMs (2002-2005) was compared with the updated evidence (E2) on that same topic in a summary resource (DynaMed 2019). Two physician-raters independently categorized each POEM-RCT as (i) reversed when E1 ≠ E2, or as (ii) not reversed, when E1 = E2. For all "Evidence Reversals" (E1 ≠ E2), we assessed the direction of change in the evidence. RESULTS We evaluated 408 POEMs on RCTs. Of those, 35 (9%; 95% confidence interval [6-12]) were identified as reversed, 359 (88%) were identified as not reversed, and 14 (3%) were indeterminate. On average, this represents about 2 evidence reversals per annum for POEMs about RCTs. CONCLUSIONS Over 12-17 years, 9% of RCTs summarized as POEMs are reversed. Information alerting services that apply strict criteria for relevance and validity of clinical information are likely to identify RCTs whose findings are stable over time.

中文翻译：

---

初级保健研究中的证据逆转：一项随机对照试验研究。

背景 循证医学建立在这样一个前提之上，即当临床医生的决定基于高质量的证据时，他们会更有信心。此外，在做出有关测试或治疗的决定时，首选来自涉及以患者为导向的结果的研究证据。理想情况下，相关有效试验的结果应该随着时间的推移保持稳定，即在后续研究中不太可能逆转。目的 评估与初级卫生保健相关的试验证据的稳定性，并确定与其逆转相关的研究特征。方法 我们研究了从 2002 年到 2005 年作为“每日 POEM”（以患者为导向的重要证据）发表的随机对照试验 (RCT) 的概要。在摘要资源 (DynaMed 2019) 中，将这些 POEM (2002-2005) 的初始证据 (E1) 与同一主题的更新证据 (E2) 进行了比较。两名医师评分员独立地将每个 POEM-RCT 分类为 (i) 当 E1 ≠ E2 时逆转，或 (ii) 当 E1 = E2 时不逆转。对于所有“证据逆转”（E1≠E2），我们评估了证据的变化方向。结果 我们在 RCT 上评估了 408 个 POEM。其中，35 个（9%；95% 置信区间 [6-12]）被确定为逆转，359 个（88%）被确定为未逆转，14 个（3%）不确定。平均而言，这代表了 POEM 每年大约 2 次关于 RCT 的证据逆转。结论 在 12-17 年间，9% 的 RCT 总结为 POEM 被逆转。