An evaluation of factors that may influence clinicians' decisions not to enroll eligible patients into randomized trials in critical care.

Mahesh Ramanan, Laurent Billot, Dorrilyn Rajbhandari, John Myburgh, Balasubramanian Venkatesh

Abstract read

In one paragraph

Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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0cells of the map it votes in

1citing papers in PubMed

–field-weighted citation impact

1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

A randomised, controlled, feasibility trial comparing vasopressors infused via peripheral cannula versus central venous access for critically ill adults: The VIPCA trial.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2025
Article

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Mahesh RamananIntensive Care Unit, Caboolture Hospital, Brisbane, Queensland, Australia.ORCID 0000-0003-4509-4015

Laurent BillotCritical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.

Dorrilyn RajbhandariCritical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.

John MyburghCritical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.

Balasubramanian VenkateshCritical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo determine the association between intensive care unit (ICU) characteristics and clinicians' decision to decline eligible patients for randomization into a multicentered pragmatic comparative-effectiveness controlled trial.

methodsScreening logs from the Adjunctive Glucocorticoid Therapy in Septic Shock Trial (ADRENAL) and site-level data from the College of Intensive Care Medicine and Australia New Zealand Intensive Care Society were examined. The effects of ICU characteristics such as tertiary academic status, research coordinator availability, number of admissions, and ICU affiliations on clinicians declining to randomize eligible patients were calculated using mixed effects logistic regression modelling.

resultsThere were 21,818 patients screened for inclusion in the ADRENAL trial at 69 sites across five countries, out of which 5,501 were eligible, 3,800 were randomized and 659 eligible patients were declined for randomization by the treating clinician. The proportion of eligible patients declined by clinicians at individual ICUs ranged from 0 to41%. In the multivariable model, none of the ICU characteristics were significantly associated with higher clinician decline rate.

conclusionsNeither tertiary academic status, nor other site-level variables were significantly associated with increased rate of clinicians declining eligible patients.

Indexed as

Clinical Decision-MakingCritical CareHumansIntensive Care UnitsLogistic ModelsMulticenter Studies as TopicPhysiciansRandomized Controlled Trials as TopicTertiary Care Centers

Identifiers

PMID34314449

DOI10.1371/journal.pone.0255361

PMCPMC8315530

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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.