Evidence map›Paper›PMID 37143091›Full record

SynthesisCritical care (London, England)2023

Heterogeneity in the definition of delirium in ICUs and association with the intervention effect in randomized controlled trials: a meta-epidemiological study.

Lucie Collet, Aymeric Lanore, Camille Alaterre, Jean-Michel Constantin, Guillaume L Martin, Agnès Caille, Arthur James, Agnès Dechartres

Abstract readMeta-Analysis
In one paragraph

Synthesis in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–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

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
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

8 authors.

Lucie ColletSorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpetrière, Département de Santé Publique, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
Aymeric Lanore *Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpetrière, Département de Santé Publique, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
Camille Alaterre *Sorbonne Université, GRC 29, DMU DREAM, AP-HP, Hôpital Pitié-Salpetrière, Département d'Anesthésie-Réanimation, Paris, France.
Jean-Michel ConstantinSorbonne Université, GRC 29, DMU DREAM, AP-HP, Hôpital Pitié-Salpetrière, Département d'Anesthésie-Réanimation, Paris, France.
Guillaume L MartinSorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpetrière, Département de Santé Publique, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
Agnès CailleUniversité́ de Tours, Université́ de Nantes, INSERM, SPHERE U1246, Tours, France; INSERM CIC 1415, CHRU de Tours, Tours, France.
Arthur JamesSorbonne Université, GRC 29, DMU DREAM, AP-HP, Hôpital Pitié-Salpetrière, Département d'Anesthésie-Réanimation, Paris, France.
Agnès DechartresSorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpetrière, Département de Santé Publique, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. agnes.dechartres@aphp.fr.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo evaluate the heterogeneity in the definition of delirium in randomized controlled trials (RCTs) included in meta-analyses of delirium in intensive care units (ICUs) and to explore whether intervention effect depends on the definition used.

methodsWe searched PubMed for meta-analyses including RCTs evaluating prevention or treatment strategies of delirium in ICU. The definition of delirium was collected from RCTs and classified as validated (DSM criteria, CAM-ICU, ICDSC, NEECHAM, DRS-R98) or non-validated (non-validated scales, set of symptoms, physician appreciation or not reported). We conducted a meta-epidemiological analysis to compare intervention effects between trials using or not a validated definition by a two-step method as primary analysis and a multilevel model as secondary analysis. A ratio of odds ratios (ROR) < 1 indicated larger intervention effects in trials using a non-validated definition.

resultsOf 149 RCTs (41 meta-analyses), 109 (73.1%) used a validated definition and 40 (26.8%) did not (including 31 [20.8%] not reporting the definition). The primary analysis of 7 meta-analyses (30 RCTs) found no significant difference in intervention effects between trials using a validated definition and the others (ROR = 0.54, 95% CI 0.27-1.08), whereas the secondary multilevel analysis including 12 meta-analyses (67 RCTs) found significantly larger effects for trials using a non-validated versus a validated definition (ROR = 0.36, 95% CI 0.21-0.62).

conclusionThe definition of delirium was heterogeneous across RCTs, with one-fifth not reporting how they evaluated delirium. We did not find a significant association with intervention effect in the primary analysis. The secondary analysis including more studies revealed significantly larger intervention effects in trials using a non-validated versus a validated definition.

Indexed as

DeliriumIntensive Care UnitsEpidemiologic StudiesHumansMeta-Analysis as TopicRandomized Controlled Trials as TopicDefinitionDeliriumHeterogeneityIntensive careMeta-analysisMeta-epidemiology

Identifiers

PMID37143091
PMCPMC10161412

What OpenQuestion holds

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Registered trials

None linked

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.