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- Granholm, Anders, et al.
(författare)
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Higher vs Lower Doses of Dexamethasone in Patients with COVID-19 and Severe Hypoxia (COVID STEROID 2) trial: Protocol for a secondary Bayesian analysis
- 2021
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Ingår i: Acta Anaesthesiologica Scandinavica. - : WILEY. - 0001-5172 .- 1399-6576. ; 65:5, s. 702-710
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Tidskriftsartikel (refereegranskat)abstract
- Background Coronavirus disease 2019 (COVID-19) can lead to severe hypoxic respiratory failure and death. Corticosteroids decrease mortality in severely or critically ill patients with COVID-19. However, the optimal dose remains unresolved. The ongoing randomised COVID STEROID 2 trial investigates the effects of higher vs lower doses of dexamethasone (12 vs 6 mg intravenously daily for up to 10 days) in 1,000 adult patients with COVID-19 and severe hypoxia. Methods This protocol outlines the rationale and statistical methods for a secondary, pre-planned Bayesian analysis of the primary outcome (days alive without life support at day 28) and all secondary outcomes registered up to day 90. We will use hurdle-negative binomial models to estimate the mean number of days alive without life support in each group and present results as mean differences and incidence rate ratios with 95% credibility intervals (CrIs). Additional count outcomes will be analysed similarly and binary outcomes will be analysed using logistic regression models with results presented as probabilities, relative risks and risk differences with 95% CrIs. We will present probabilities of any benefit/harm, clinically important benefit/harm and probabilities of effects smaller than pre-defined clinically minimally important differences for all outcomes analysed. Analyses will be adjusted for stratification variables and conducted using weakly informative priors supplemented by sensitivity analyses using sceptic priors. Discussion This secondary, pre-planned Bayesian analysis will supplement the primary, conventional analysis and may help clinicians, researchers and policymakers interpret the results of the COVID STEROID 2 trial while avoiding arbitrarily dichotomised interpretations of the results. Trial registration ClinicalTrials.gov: NCT04509973; EudraCT: 2020-003363-25.
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- Sanfilippo, Filippo, et al.
(författare)
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The PRICES statement: an ESICM expert consensus on methodology for conducting and reporting critical care echocardiography research studies
- 2021
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Ingår i: Intensive Care Medicine. - : SPRINGER. - 0342-4642 .- 1432-1238. ; 47:1, s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Echocardiography is a common tool for cardiac and hemodynamic assessments in critical care research. However, interpretation (and applications) of results and between-study comparisons are often difficult due to the lack of certain important details in the studies. PRICES (Preferred Reporting Items for Critical care Echocardiography Studies) is a project endorsed by the European Society of Intensive Care Medicine and conducted by the Echocardiography Working Group, aiming at producing recommendations for standardized reporting of critical care echocardiography (CCE) research studies. Methods: The PRICE panel identified lists of clinical and echocardiographic parameters (the "items") deemed important in four main areas of CCE research: left ventricular systolic and diastolic functions, right ventricular function and fluid management. Each item was graded using a critical index (CI) that combined the relative importance of each item and the fraction of studies that did not report it, also taking experts opinion into account. Results: A list of items in each area that deemed essential for the proper interpretation and application of research results is recommended. Additional items which aid interpretation were also proposed. Conclusion: The PRICES recommendations reported in this document, as a checklist, represent an international consensus of experts as to which parameters and information should be included in the design of echocardiography research studies. PRICES recommendations provide guidance to scientists in the field of CCE with the objective of providing a recommended framework for reporting of CCE methodology and results.
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- Ydenius, Viktor, et al.
(författare)
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Impact of hospital type on risk-adjusted, traffic-related 30-day mortality : a population-based registry study
- 2021
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Ingår i: Burns & Trauma. - : Oxford University Press. - 2321-3876. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Traffic incidents are still a major contributor to hospital admissions and trauma-relatedmortality. The aim of this nationwide study was to examine risk-adjusted traffic injury mortality todetermine whether hospital type was an independent survival factor.Methods: Data on all patients admitted to Swedish hospitals with traffic-related injuries, basedon International Classification of Diseases codes, between 2001 and 2011 were extracted fromthe Swedish inpatient and cause of death registries. Using the binary outcome measure of deathor survival, data were analysed using logistic regression, adjusting for age, sex, comorbidity,severity of injury and hospital type. The severity of injury was established using the InternationalClassification of Diseases Injury Severity Score (ICISS).Results: The final study population consisted of 152,693 hospital admissions. Young individuals(0–25 years of age) were overrepresented, accounting for 41% of traffic-related injuries. Menwere overrepresented in all age categories. Fatalities at university hospitals had the lowest mean(SD) ICISS 0.68 (0.19). Regional and county hospitals had mean ICISS 0.75 (0.15) and 0.77 (0.15),respectively, for fatal traffic incidents. The crude overall mortality in the study population was 1193,with a mean ICISS 0.72 (0.17). Fatalities at university hospitals had the lowest mean ICISS 0.68(0.19). Regional and county hospitals had mean ICISS 0.75 (0.15) and 0.77 (0.15), respectively, forfatal traffic incidents. When regional and county hospitals were merged into one group and itsrisk-adjusted mortality compared with university hospitals, no significant difference was found. Acomparison between hospital groups with the most severely injured patients (ICISS ≤0.85) also didnot show a significant difference (odds ratio, 1.13; 95% confidence interval, 0.97–1.32).Conclusions: This study shows that, in Sweden, the type of hospital does not influence risk adjustedtraffic related mortality, where the most severely injured patients are transported to the universityhospitals and centralization of treatment is common.
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