ReviewCritical care (London, England)2025
Estimating bias from withdrawal of life sustaining treatment in clinical trials.
Review in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 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
5 citing papers in PubMed.
- Clinicians' Approaches to Prognostication After Traumatic Brain Injury and Cardiac Arrest: A Multi-Hospital, Qualitative Study.Neurocritical care · 2026Article
- Wolf Creek XVIII Part 6: transforming clinical trial design in cardiac arrest research.Resuscitation plus · 2026Article
- Early Physiologic Deterioration versus True Risk Prediction: Methodological Considerations for SALI Nomogram Development.Shock (Augusta, Ga.) · 2026Article
- Reporting practices and impact of withdrawal of life-sustaining treatment on outcomes in acute brain injury clinical trials: a literature review and simulation study.Critical care (London, England) · 2026Review
- Withdrawal of life-sustaining therapies after cardiac arrest.Current opinion in critical care · 2025Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
Abstract
Withdrawal of life sustaining treatment (WLST) is common in critically ill patients and confers a high probability of in-hospital death. In clinical trials, WLST is a specific example of a post-randomization intervention with a strong influence on outcome that can bias estimates of treatment effect. Only under several strong assumptions do the observed effects from randomized treatment in the presence of WLST correspond to those expected in its absence. However, WLST is rarely accounted for in trials. We propose a systematic approach to analyze the rates of WLST and characteristics of trial participants who died after WLST in order to identify when bias is present, and sensitivity analyses to set bounds on the direction and magnitude of this bias. In an example randomized trial of treatments for out-of-hospital cardiac arrest, the bias attributable to WLST reduces the observed treatment effects. Sensitivity analyses set bounds on this bias and estimate hypothetical treatment effects that might have been observed in the absence of WLST. This approach provides better insight into the observed results of the trial.
Indexed as
Identifiers
What OpenQuestion holds
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.