Article Text

Uses and misuses of the STROBE statement: bibliographic study
  1. Bruno R da Costa1,
  2. Myriam Cevallos1,2,
  3. Douglas G Altman3,
  4. Anne W S Rutjes1,
  5. Matthias Egger1
  1. 1Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland
  2. 2Clinical Trials Unit Bern, Bern University Hospital, Bern, Switzerland
  3. 3Centre for Statistics in Medicine, University of Oxford, Oxford, UK
  1. Correspondence to Dr Bruno R da Costa; bdacosta{at}


Objectives Appropriate reporting is central to the application of findings from research to clinical practice. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations consist of a checklist of 22 items that provide guidance on the reporting of cohort, case–control and cross-sectional studies, in order to facilitate critical appraisal and interpretation of results. STROBE was published in October 2007 in several journals including The Lancet, BMJ, Annals of Internal Medicine and PLoS Medicine. Within the framework of the revision of the STROBE recommendations, the authors examined the context and circumstances in which the STROBE statement was used in the past.

Design The authors searched the Web of Science database in August 2010 for articles which cited STROBE and examined a random sample of 100 articles using a standardised, piloted data extraction form. The use of STROBE in observational studies and systematic reviews (including meta-analyses) was classified as appropriate or inappropriate. The use of STROBE to guide the reporting of observational studies was considered appropriate. Inappropriate uses included the use of STROBE as a tool to assess the methodological quality of studies or as a guideline on how to design and conduct studies.

Results The authors identified 640 articles that cited STROBE. In the random sample of 100 articles, about half were observational studies (32%) or systematic reviews (19%). Comments, editorials and letters accounted for 15%, methodological articles for 8%, and recommendations and narrative reviews for 26% of articles. Of the 32 observational studies, 26 (81%) made appropriate use of STROBE, and three uses (10%) were considered inappropriate. Among 19 systematic reviews, 10 (53%) used STROBE inappropriately as a tool to assess study quality.

Conclusions The STROBE reporting recommendations are frequently used inappropriately in systematic reviews and meta-analyses as an instrument to assess the methodological quality of observational studies.

  • Rheumatology
  • public health
  • rehabilitation medicine
  • epidemiology
  • systematic reviews
  • prognostic studies
  • statistics
  • research designs in field of test evaluations
  • heterogeneity
  • bias
  • diagnostic accuracy
  • metaanalysis
  • social medicine
  • reporting guideline
  • methodological study
  • methodological quality
  • quality assessment

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  • To cite: da Costa BR, Cevallos M, Altman DG, et al. Uses and misuses of the STROBE statement: bibliographic study. BMJ Open 2011;1:e000048. doi:10.1136/bmjopen-2010-000048

  • Funding BRdC is supported by a grant from the ARCO Foundation, Switzerland. STROBE is supported by the Swiss National Science Foundation and the Schweizerische Akademie der Medizinischen Wissenschaften.

  • Competing interests BRdC, MC, DGA, and ME are members of the group revising the STROBE statement.

  • Contributors All authors conceptualised the ideas in the manuscript, and read and approved the manuscript. BRdC developed the first draft and incorporated comments from authors for successive drafts. BRdC is the guarantor of this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.