ArticleThe journal of trauma and acute care surgery2013
Seven deadly sins in trauma outcomes research: an epidemiologic post mortem for major causes of bias.
Article in The journal of trauma and acute care surgery, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Systemic hemostatic agents initiated in trauma patients in the pre-hospital setting: a systematic review.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2023Pooled it
- Resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and uncontrolled haemorrhagic shock: a systematic review with meta-analysis.World journal of emergency surgery : WJES · 2021Pooled it
- A meta-analysis of resuscitative endovascular balloon occlusion of the aorta (REBOA) or open aortic cross-clamping by resuscitative thoracotomy in non-compressible torso hemorrhage patients.World journal of emergency surgery : WJES · 2017Pooled it
- Association of transfusion red blood cell storage age and blood oxygenation, long-term neurologic outcome, and mortality in traumatic brain injury.The journal of trauma and acute care surgery · 2015Trial
- Trial
- Prehospital tourniquet use and associated outcomes in a low-resource conflict setting: prospective observational casualty data and tourniquet classification system from the Sahel.BMJ military health · 2026Article
- Timing of fracture fixation for femur and pelvis fractures in patients with severe traumatic brain injury - an analysis of the TraumaRegister DGUEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Sex, time, and disability status differences in mortality, multidimensional morbidity, and health care utilization: a secondary analysis of the Canadian RECOVER study.Intensive care medicine · 2026Article
- Epidemiology of prehospital traumatic cardiac arrest in Geneva: a retrospective cohort study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- Unaddressed pitfalls in trauma resuscitation research: A critical appraisal of Van Wessem et al. (2025)".European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Article
- Challenges in colorectal cancer post-surgical surveillance: A critical evaluation and path forward.World journal of gastrointestinal surgery · 2025Article
- Physician-led interprofessional pre-hospital teams: does the science hold up?Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- Article
- Characteristics of injuries during the 2006 Lebanon conflict: a three-center retrospective study of survivors, 16 years after the conflict.Frontiers in public health · 2024Article
- Association of Time to Definitive Hemostasis With Mortality in Patients With Solid Organ Injuries.Cureus · 2023Article
- The forgotten cohort-lessons learned from prehospital trauma death: a retrospective cohort study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2023Article
- Retrospective study on rib fractures: smoking and alcohol matter for mortality and complications.Trauma surgery & acute care open · 2021Article
- Interim monitoring of nonrandomized prospective studies that invoke propensity scoring for decision making.The journal of trauma and acute care surgery · 2020Article
- Massive Transfusion Protocols for Pediatric Patients: Current Perspectives.Journal of blood medicine · 2020Review
- Mortality of civilian patients with suspected traumatic haemorrhage receiving pre-hospital transfusion of packed red blood cells compared to pre-hospital crystalloid.Scandinavian journal of trauma, resuscitation and emergency medicine · 2018Observational
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundBecause randomized clinical trials in trauma outcomes research are expensive and complex, they have rarely been the basis for the clinical care of trauma patients. Most published findings are derived from retrospective and occasionally prospective observational studies that may be particularly susceptible to bias. The sources of bias include some common to other clinical domains, such as heterogeneous patient populations with competing and interdependent short- and long-term outcomes. Other sources of bias are unique to trauma, such as rapidly changing multisystem responses to injury that necessitate highly dynamic treatment regimens such as blood product transfusion. The standard research design and analysis strategies applied in published observational studies are often inadequate to address these biases.
methodsDrawing on recent experience in the design, data collection, monitoring, and analysis of the 10-site observational PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study, 7 common and sometimes overlapping biases are described through examples and resolution strategies.
resultsSources of bias in trauma research include ignoring (1) variation in patients' indications for treatment (indication bias), (2) the dependency of intervention delivery on patient survival (survival bias), (3) time-varying treatment, (4) time-dependent confounding, (5) nonuniform intervention effects over time, (6) nonrandom missing data mechanisms, and (7) imperfectly defined variables. This list is not exhaustive.
conclusionThe mitigation strategies to overcome these threats to validity require epidemiologic and statistical vigilance. Minimizing the highlighted types of bias in trauma research will facilitate clinical translation of more accurate and reproducible findings and improve the evidence-base that clinicians apply in their care of injured patients.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.