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However, many eligible studies included in this meta-analysis did not consider the environmental factors.
We considered it unlikely that there were many eligible studies preceding this date and were concerned about changes in treatment delivery since the early 1980s.
To minimise these biases, we conducted a thorough search of literature and consulted experts to identify as many eligible studies as possible.
Although such searches are problematic due to lack of specific indexing terms, an extensive search strategy was devised to identify as many eligible studies as possible.
We updated the literature search of the above electronic databases on 15 October 2012 to find as many eligible studies as possible.
Because the search found so many eligible studies, we were able to group together methods which had been applied to diverse clinical disciplines and appraise the strengths, limitations and clinical utility of each.
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While we determined a priori to focus on change values because scoping of the literature indicated that many of the possibly eligible studies were small, many studies did not report change values.
Although eligible studies met many of the QUADAS criteria, weaknesses remained.
To include all the eligible studies as many as possible and diminish the language bias in this systematic review, we didn't apply any restrictions about the language when we searched the database, such as PubMed, Embase.
One limitation of our study is that many eligible patients were not enrolled because of difficulty in obtaining consent, or because they were not asked to participate by the surgeon at the Emergency Department.
In many systematic reviews only some of the eligible studies (often a minority) can be included in a meta-analysis for a specific outcome.
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