Observational studyCritical care medicine2015
Protocols and Hospital Mortality in Critically Ill Patients: The United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study.
Observational study in Critical care medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis 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
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 51 citations in OpenAlex.
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.Intensive care medicine · 2017Guideline
- Article
- A decade of the ORCHESTRA study: organizational characteristics, patient outcomes, performance and efficiency in critical care.Critical care science · 2024Article
- Incidence of Acute Upper Gastrointestinal Bleeding and Related Risk Factors among Elderly Patients Undergoing Surgery for Major Limb Fractures: An Analytical Cohort Study.Healthcare (Basel, Switzerland) · 2023Article
- Differences in Prevalence of Transfusion Protocols between Critically Ill Neurologic and Non-Neurologic Patient Populations.Journal of clinical medicine · 2023Article
- Systematized and efficient: organization of critical care in the future.Critical care (London, England) · 2022Review
- Article
- Should we routinely prescribe proton pump inhibitors peri-operatively in elderly patients with hip fractures? A review of the literature.EFORT open reviews · 2021Review
- Handoffs and transitions in critical care-understanding scalability: study protocol for a multicenter stepped wedge type 2 hybrid effectiveness-implementation trial.Implementation science : IS · 2021Article
- Voluntarily reported prescribing, monitoring and medication transfer errors in intensive care units in The Netherlands.International journal of clinical pharmacy · 2021Article
- Individualized Care Is Superior to Standardized Care for the Majority of Critically Ill Patients.Critical care medicine · 2020Article
- Risk factors for the development of acute respiratory distress syndrome in mechanically ventilated adults in Peru: a multicenter observational study.Critical care (London, England) · 2019Observational
- ICU staffing feature phenotypes and their relationship with patients' outcomes: an unsupervised machine learning analysis.Intensive care medicine · 2019Article
- Health inequities in the diagnosis and outcome of sepsis in Argentina: a prospective cohort study.Critical care (London, England) · 2019Article
- Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study.BMJ (Clinical research ed.) · 2019Article
- Impact of random safety analyses on structure, process and outcome indicators: multicentre study.Annals of intensive care · 2017Article
- Do hospitals need oncological critical care units?Journal of thoracic disease · 2017Article
- Evaluation of RBC Transfusion Practice in Adult ICUs and the Effect of Restrictive Transfusion Protocols on Routine Care.Critical care medicine · 2017Observational
- Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. An International Survey.Annals of the American Thoracic Society · 2016Article
- Intensive Care in India: The Indian Intensive Care Case Mix and Practice Patterns Study.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2016Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
29 authors at 9 institutions in 1 country.
Funding
Abstract
objectiveClinical protocols may decrease unnecessary variation in care and improve compliance with desirable therapies. We evaluated whether highly protocolized ICUs have superior patient outcomes compared with less highly protocolized ICUs.
designObservational study in which participating ICUs completed a general assessment and enrolled new patients 1 day each week. PATIENTS: A total of 6,179 critically ill patients.
settingFifty-nine ICUs in the United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study.
interventionsNone. MEASUREMENTS AND MAIN
resultsThe primary exposure was the number of ICU protocols; the primary outcome was hospital mortality. A total of 5,809 participants were followed prospectively, and 5,454 patients in 57 ICUs had complete outcome data. The median number of protocols per ICU was 19 (interquartile range, 15-21.5). In single-variable analyses, there were no differences in ICU and hospital mortality, length of stay, use of mechanical ventilation, vasopressors, or continuous sedation among individuals in ICUs with a high versus low number of protocols. The lack of association was confirmed in adjusted multivariable analysis (p = 0.70). Protocol compliance with two ventilator management protocols was moderate and did not differ between ICUs with high versus low numbers of protocols for lung protective ventilation in acute respiratory distress syndrome (47% vs 52%; p = 0.28) and for spontaneous breathing trials (55% vs 51%; p = 0.27).
conclusionsClinical protocols are highly prevalent in U.S. ICUs. The presence of a greater number of protocols was not associated with protocol compliance or patient mortality.
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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.