/meta-analysis

name: meta-analysis
description: Use when running a systematic review and meta-analysis, DTA or intervention. Covers PROSPERO protocol, search, screening, extraction, risk of bias (QUADAS-3, RoB 2, ROBINS-I), bivariate/HSROC or random-effects pooling, forest plots, heterogeneity and PRISMA reporting. Topic scouting is /ma-scout.
metadata:
  triggers: "meta-analysis, systematic review, PROSPERO, QUADAS-3, forest plot, funnel plot, PRISMA, QUADAS, ROBINS, HSROC, bivariate model, pooled sensitivity, pooled specificity, search strategy, study selection, data extraction form"

Meta-Analysis Skill

Meta-Analysis Types

| Type | RoB Tool | Statistical Model | Reporting Guideline | |------|----------|-------------------|-------------------| | **DTA** (diagnostic test accuracy) | **QUADAS-3** (QUADAS-2 for legacy reviews) | Bivariate / HSROC | PRISMA-DTA | | **Intervention** (treatment effect) | RoB 2 (RCT) / ROBINS-I (NRSI) | Random-effects (REML, Hartung-Knapp CI) | PRISMA 2020 | | **Prognostic factor** (association of one factor with outcome) | QUIPS | Random-effects | PRISMA 2020 | | **Prediction model** (model performance) | PROBAST | Random-effects | PRISMA 2020 | | **Observational** (prevalence/association) | NOS / JBI | Random-effects | MOOSE |

If the type is ambiguous (DTA vs intervention), ask the user to clarify before proceeding.

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Workflow Phases

Phase 1: Protocol Development

**Goal**: Produce a PROSPERO-ready protocol document. Write the protocol, extraction forms and manuscript text in English whatever language the user writes in — PROSPERO records and the target journals are English-language.

1. **Research question**: PIRD (Population, Index test, Reference standard, Diagnosis) for DTA; PICO (Population, Intervention, Comparator, Outcome) for intervention.

2. **DTA only — do QUADAS-3 phases 1 and 2 now, not at risk-of-bias time.** They are review-level and belong in the protocol: phase 1 states the **synthesis question(s)** (population, index test(s), target condition — a review may have more than one); phase 2 defines the **ideal test accuracy trial** for each (objective, participants, index test(s), definition of the target condition, analysis). Every later risk-of-bias and applicability judgement is made against that trial. Write the review-specific guidance for answering each signalling question here too, with clinical **and** methodological input, and publish it as a web appendix. Defining the ideal trial after seeing the studies is a judgement fitted to the results, not an assessment. See `references/checklists/QUADAS3.md`.

3. **Eligibility criteria**: study design, population, index test / intervention, comparator / reference standard, outcomes (Se/Sp for DTA; effect size for intervention), and exclusion criteria with justification.

4. **Search plan**: at least 3 databases — PubMed, Embase, and Cochrane CENTRAL (add Scopus / Web of Science as needed); a Boolean strategy from the PIRD/PICO components; a grey-literature plan (conference abstracts, trial registries); language restrictions and date range stated explicitly, with justification.

5. **RoB plan**: tool by type (table above), at least 2 independent assessors, and the disagreement-resolution method (consensus, third reviewer).

6. **Synthesis plan**: bivariate random-effects (Reitsma) or HSROC (Rutter & Gatsonis) for DTA; random-effects for intervention (Phase 6); heterogeneity, subgroup / sensitivity, and publication-bias plans.

7. **PROSPERO registration document**: read `${CLAUDE_SKILL_DIR}/references/PROSPERO_template.md` and follow its field guide, word limits, output format (Markdown + DOCX via pandoc), and Common Pitfalls Checklist. Save to the project's `7_Submission/` or equivalent directory.

• **Submit before the formal search, and record the date.** The user submits the registration;

record the initial submission date (not the later date the record is published) in the project's status file (`STATUS.md`, `project_state.json` or `project.yaml`, whichever the project keeps). The Phase 2 entry check looks for it. A pilot search is fine before submission; the formal search, screening and extraction, AI first-pass drafts included, are not.

• **Registration-ID format gate.** A PROSPERO ID is `CRD42` + 9 digits (14 characters total),

e.g. `CRD42024500001`. Validate any ID that appears in the manuscript or registration doc with `grep -oE 'CRD42[0-9]+'` and assert a 14-character length / `^CRD42\d{9}$` — a 15-character ID (a stray digit) is a transcription error a reviewer will check against the live record.

• **Review-type selection.** Pick the *least-wrong* portal review type for the actual design and

state any portal constraint in the protocol. A descriptive single-arm proportion synthesis is not an "Intervention review"; choosing that type only to satisfy a portal field contradicts a later GRADE / effect-certainty statement. Whatever certainty language the protocol commits to (GRADE vs "evidence statements only") must match the manuscript verbatim — a guideline-style "we recommend" is not licensed by a descriptive review type.

Phase 2: Search Strategy

**Goal**: Develop and validate reproducible search strategies.

**Entry check — registration before the formal search.** Look for the registration submission date recorded in Phase 1 step 7. If none is recorded, stop and ask the user to choose: submit the registration now and run the search after that date, or proceed without it, in which case Phase 8 item 5 limits what the manuscript may claim. Record the choice. Screening or extraction done before submission, AI first-pass drafts included, cannot be made prospective afterwards. Under `/orchestrate --e2e` this stop is the `REGISTRATION_PENDING` halt; no autonomous default passes it.

1. Build search blocks from the PIRD/PICO components and execute them