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Title: The Fragility Index in Multicenter Randomized Controlled Critical Care Trials.
Austin Authors: Ridgeon, Elliott E;Young, Paul J;Bellomo, Rinaldo ;Mucchetti, Marta;Lembo, Rosalba;Landoni, Giovanni
Affiliation: Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
Faculty of Medicine, the University of Melbourne and Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
Medical Research Institute of New Zealand, Wellington, New Zealand
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
Vita-Salute San Raffaele University, Milan, Italy
Issue Date: Jul-2016
Publication information: Critical Care Medicine 2016; 44(7): 1278-1284
Abstract: Recent literature has drawn attention to the potential inadequacy of frequentist analysis and threshold p values as tools for reporting outcomes in clinical trials. The fragility index, which is a measure of how many events the statistical significance of a result depends on, has been suggested as a means to aid the interpretation of trial results. This study aimed to calculate the fragility index of clinical trials in critical care medicine reporting a statistically significant effect on mortality (increasing or decreasing mortality). Literature search (PubMed/MEDLINE) to identify all multicenter randomized controlled trials in critical care medicine. We identified 862 trials; of which 56 fulfilled eligibility criteria and were included in our analysis. Calculation of fragility index for trials reporting a statistically significant effect on mortality, and analysis of the relationship between trial characteristics and fragility index. The median fragility index was 2 (interquartile range, 1-3.5), and greater than 40% of trials had a fragility index of less than or equal to 1. 12.5% of trials reported loss to follow-up greater than their fragility index. Trial sample size was positively correlated, and reported p value was negatively correlated, with fragility index. In critical care trials reporting statistically significant effects on mortality, the findings often depend on a small number of events. Critical care clinicians should be wary of basing decisions on trials with a low fragility index. We advocate the reporting of fragility index for future trials in critical care to aid interpretation and decision making by clinicians.
DOI: 10.1097/CCM.0000000000001670
PubMed URL: 26963326
Type: Journal Article
Appears in Collections:Journal articles

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