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Forest Plots LAST UPDATED: 21ST APRIL 2019

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The results of a meta-analysis are presented as a forest plot of pooled results, which provides graphical representation
of the strength of evidence of the constituent trials.

Forest Plots Heterogeneity

Evidence Based Medicine

FRCEM Success Forest plots provides visual evidence of heterogeneity if present. Heterogeneity occurs when there is more variation
between studies than would be expected by chance alone, even after allowing for random variation.

Heterogeneity is indicated if the con dence interval of a study does not overlap with any of the con dence intervals of
the other studies. If the horizontal lines all overlap to some extent the trials are homogenous, where the observed
di erences are due to random variation.

Interpretation

The left-hand column lists the names of the studies, commonly in chronological order from the top downwards.

The right-hand column is a plot of the measure of e ect size, for example an odds ratio (OR), for each of these studies,
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represented by a square:
Forest Plot
The midpoint of the square represents the e ect size.
The width of the horizontal lines extending from the square represents the 95% con dence interval for this e ect
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size.
Evidence Based Medicine Statistics
The area of each square is proportional to the weight given to that study in the meta-analysis (studies with larger
sample sizes, and more e ect sizes are given more weight).
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The overall meta-analysed summary e ect size is plotted as a diamond:

The midpoint of the diamond represents the summary e ect size.

The lateral points represent the 95% con dence interval for this estimate.
There may be an ascending dotted line from the upper point of the diamond.

There is a vertical line of no e ect which intersects the horizontal axis at the point at which there is no di erence
between the interventions.

If the con dence intervals for individual studies overlap with this line, it demonstrates that at the given level of
con dence the e ect size does not di er from no e ect for that individual study and therefore the results are not
statistically signi cant. If the horizontal line does not cross the line, the results are statistically signi cant.
The same applies for the summary measure of e ect: if the points of the diamond overlap the line of no e ect the
summary e ect size cannot be said to di er from no e ect at the given level of con dence and the results are not
statistically signi cant.

FO REST PLOT. (IMAGE BY JAMES GRELLIER (OWN WORK) [CC BY-SA 3 .0 (HTTP://CR EATIVECO MMO NS .ORG/LIC ENS ES/BY-SA/3.0)], V IA

WIKIMEDIA COMMONS)