Discussion sections in reports of controlled trials published in general medical journals - Islands in search of continents?

Context.-Several journals have adopted the Consolidated Standards of Reporting Trials (CONSORT) recommendations to make assessment of the quality of randomized controlled trials (RCTs) easier. One of these recommendations is that the trial's results be discussed in light of the totality of the available evidence. Objective.-To assess the extent to which reports of RCTs published in 5 general medical journals have discussed new results in light of all available evidence. Design.-Assessment of the discussion sections in all 26 reports of RCTs published during May 1997 in Annals of Infernal Medicine, BMJ, JAMA, The Lancet, and The New England Journal of Medicine. Main Outcome Measure.-The inclusion or mention of a systematic review in the discussion section of each article. Results.-ln only 2 articles were the RCT's results discussed in the context of an updated systematic review of earlier trials. In a further 4 articles, references were made to relevant systematic reviews, but no attempts were made to integrate the results of the new trials in updated versions of these reviews. One article was probably the first published trial to address the question studied. The remaining 19 articles included no evidence that any systematic attempt had been made to set the reported trial's results in the context of previous trials. Conclusion.-There is little evidence that journals have adequately implemented the CONSORT recommendation that results of an RCT be discussed in light of the totality of the available evidence.