ArticleBMC medicine2020
Treatment estimands in clinical trials of patients hospitalised for COVID-19: ensuring trials ask the right questions.
Article in BMC medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 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
19 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Evaluating how clear the questions being investigated in randomised trials are: systematic review of estimands.BMJ (Clinical research ed.) · 2022Pooled it
- Estimands for factorial trials.Statistics in medicine · 2022Trial
- Defining estimands in anaesthesia clinical trials: a scoping review and framework.British journal of anaesthesia · 2026Article
- Making Sense of Hierarchical Composite End Points in Randomized Clinical Trials-A Primer for Infectious Diseases Clinicians and Researchers.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Review
- Core outcome sets in cancer clinical trials: current status and future opportunities-an EORTC perspective.Trials · 2025Article
- Article
- Article
- The estimands framework: a primer on the ICH E9(R1) addendum.BMJ (Clinical research ed.) · 2024Article
- Eliminating Ambiguous Treatment Effects Using Estimands.American journal of epidemiology · 2023Article
- Estimands in cluster-randomized trials: choosing analyses that answer the right question.International journal of epidemiology · 2023Article
- Rethinking intercurrent events in defining estimands for tuberculosis trials.Clinical trials (London, England) · 2022Article
- Re-randomisation trials in multi-episode settings: Estimands and independence estimators.Statistical methods in medical research · 2022Article
- Functional Loss and Mortality in Randomized Clinical Trials for Amyotrophic Lateral Sclerosis: To Combine, or Not to Combine-That is the Estimand.Clinical pharmacology and therapeutics · 2022Review
- Design aspects of COVID-19 treatment trials: Improving probability and time of favorable events.Biometrical journal. Biometrische Zeitschrift · 2022Article
- Article
- Review
- Why ITT analysis is not always the answer for estimating treatment effects in clinical trials.Contemporary clinical trials · 2021Article
- Infectious diseases epidemiology, quantitative methodology, and clinical research in the midst of the COVID-19 pandemic: Perspective from a European country.Contemporary clinical trials · 2020Article
- The Wilcoxon-Mann-Whitney Estimand Versus Differences in Medians or Means.Pharmaceutical statisticsArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors.
Funding
Abstract
When designing a clinical trial, explicitly defining the treatment estimands of interest (that which is to be estimated) can help to clarify trial objectives and ensure the questions being addressed by the trial are clinically meaningful. There are several challenges when defining estimands. Here, we discuss a number of these in the context of trials of treatments for patients hospitalised with COVID-19 and make suggestions for how estimands should be defined for key outcomes. We suggest that treatment effects should usually be measured as differences in proportions (or risk or odds ratios) for outcomes such as death and requirement for ventilation, and differences in means for outcomes such as the number of days ventilated. We further recommend that truncation due to death should be handled differently depending on whether a patient- or resource-focused perspective is taken; for the former, a composite approach should be used, while for the latter, a while-alive approach is preferred. Finally, we suggest that discontinuation of randomised treatment should be handled from a treatment policy perspective, where non-adherence is ignored in the analysis (i.e. intention to treat).
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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.