A systematic review comparing two antihypertensives calculates I² = 78%. The most appropriate next step in the meta-analysis is:
- A Proceed with fixed-effects pooling
- B Discard the meta-analysis as inconclusive
- C Use random-effects model and explore sources of heterogeneity ✓
- D Apply funnel plot asymmetry correction only
Correct answer: C. Use random-effects model and explore sources of heterogeneity
Explanation
An I² of 78% indicates substantial heterogeneity (>75%). The appropriate approach is to use a random-effects model rather than fixed-effects pooling, and to explore the source of heterogeneity through subgroup analysis or meta-regression. Discarding the analysis is not standard practice; funnel plot asymmetry addresses publication bias, not statistical heterogeneity.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
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