SynthesisCritical care (London, England)2023
Positive single-center randomized trials and subsequent multicenter randomized trials in critically ill patients: a systematic review.
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 14 papers.
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
14 citing papers in PubMed.
- Letter to the Editor: The Effects of Throat Packing and Gender on Post Operative Nausea, Vomiting, and Sore Throat in Septorhinoplasty Patients: A Randomized Controlled Trial.Aesthetic plastic surgery · 2026Trial
- Renal resistive index-guided mean arterial pressure titration in sepsis: a prospective single-center, single-blind, parallel-group randomized controlled trial.Nature communications · 2026Trial
- Response to the Comments of Qayyum et al to the Manuscript "The Effects of Throat Packing and Gender on Postoperative Nausea, Vomiting, and Sore Throat in Septorhinoplasty Patients: A Randomized Controlled Trial".Aesthetic plastic surgery · 2026Article
- Evaluating global health programmes targeting under-5 mortality: problems and recommendations.BMJ global health · 2026Article
- Extraction and reimplantation of cardiac implantable electronic devices in patients with non-surgically treated infective endocarditis: a nationwide cohort study.European heart journal open · 2026Article
- Beyond cardiac fibroblasts: research advances on understanding and targeting intercellular communication networks in cardiac fibrosis.Frontiers in cardiovascular medicine · 2026Review
- Flawed design and selection bias in critical care randomized controlled trials (RCTs): the patient safety risk of the "RCT mimic".Patient safety in surgery · 2025Review
- Novel therapies and interventions in sepsis and septic shock.BJA education · 2025Review
- Perspectives on the Role of Thoracic Fascial Blocks in Cardiac Anaesthesia: Will They Represent a New Era?Journal of clinical medicine · 2025Article
- Using protection motivation theory to support patient adherence in healthcare settings: A scoping review.PloS one · 2025Article
- Hematological picture of pediatric Sudanese patients with visceral leishmaniasis and prediction of leishmania donovani parasite load.World journal of clinical cases · 2024Article
- The times are changing: A primer on novel clinical trial designs and endpoints in critical care research.American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists · 2024Article
- [Data-driven intensive care: a lack of comprehensive datasets].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2024Review
- Assessing the Clinical Usefulness and Transparency of Knee Arthroplasty Randomized Controlled Trials (2020-2024): A Systematic Review Using the van't Hooft Framework.JB & JS open accessReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIt is unclear how often survival benefits observed in single-center randomized controlled trials (sRCTs) involving critically ill patients are confirmed by subsequent multicenter randomized controlled trials (mRCTs). We aimed to perform a systemic literature review of sRCTs with a statistically significant mortality reduction and to evaluate whether subsequent mRCTs confirmed such reduction.
methodsWe searched PubMed for sRCTs published in the New England Journal of Medicine, JAMA, or Lancet, from inception until December 31, 2016. We selected studies reporting a statistically significant mortality decrease using any intervention (drug, technique, or strategy) in adult critically ill patients. We then searched for subsequent mRCTs addressing the same research question tested by the sRCT. We compared the concordance of results between sRCTs and mRCTs when any mRCT was available. We registered this systematic review in the PROSPERO International Prospective Register of Systematic Reviews (CRD42023455362).
resultsWe identified 19 sRCTs reporting a significant mortality reduction in adult critically ill patients. For 16 sRCTs, we identified at least one subsequent mRCT (24 trials in total), while the interventions from three sRCTs have not yet been addressed in a subsequent mRCT. Only one out of 16 sRCTs (6%) was followed by a mRCT replicating a significant mortality reduction; 14 (88%) were followed by mRCTs with no mortality difference. The positive finding of one sRCT (6%) on intensive glycemic control was contradicted by a subsequent mRCT showing a significant mortality increase. Of the 14 sRCTs referenced at least once in international guidelines, six (43%) have since been either removed or suggested against in the most recent versions of relevant guidelines.
conclusionMortality reduction shown by sRCTs is typically not replicated by mRCTs. The findings of sRCTs should be considered hypothesis-generating and should not contribute to guidelines.
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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.