Title
Clinical trials in critical care: can a Bayesian approach enhance clinical and scientific decision making?
Date Issued
01 February 2021
Access level
open access
Resource Type
review
Author(s)
Yarnell C.J.
Abrams D.
Brodie D.
Fan E.
Ferguson N.D.
Hua M.
Madahar P.
McAuley D.F.
Munshi L.
Perkins G.D.
Rubenfeld G.
Slutsky A.S.
Wunsch H.
Fowler R.A.
Tomlinson G.
Beitler J.R.
Goligher E.C.
Columbia University College of Physicians and Surgeons and New York-Presbyterian Hospital
Publisher(s)
Lancet Publishing Group
Abstract
Recent Bayesian reanalyses of prominent trials in critical illness have generated controversy by contradicting the initial conclusions based on conventional frequentist analyses. Many clinicians might be sceptical that Bayesian analysis, a philosophical and statistical approach that combines prior beliefs with data to generate probabilities, provides more useful information about clinical trials than the frequentist approach. In this Personal View, we introduce clinicians to the rationale, process, and interpretation of Bayesian analysis through a systematic review and reanalysis of interventional trials in critical illness. In the majority of cases, Bayesian and frequentist analyses agreed. In the remainder, Bayesian analysis identified interventions where benefit was probable despite the absence of statistical significance, where interpretation depended substantially on choice of prior distribution, and where benefit was improbable despite statistical significance. Bayesian analysis in critical care medicine can help to distinguish harm from uncertainty and establish the probability of clinically important benefit for clinicians, policy makers, and patients.
Start page
207
End page
216
Volume
9
Issue
2
Language
English
OCDE Knowledge area
Estadísticas, Probabilidad
Otras ciencias médicas
Scopus EID
2-s2.0-85097427876
PubMed ID
Source
The Lancet Respiratory Medicine
ISSN of the container
22132600
Sponsor(s)
We thank Bijan Teja, Ian Roberts, and Simon Gates for helpful comments. The study was funded by the Canadian Institutes for Health Research Canada Graduate Scholarship – Master's Awards programme, the Eliot Phillipson Clinician Scientist Training Program, the Clinician Investigator Program of the University of Toronto (CJY), and the US National Institutes of Health (K23-HL133489, R21-HL145506; principal investigator: JRB). MH is supported by a Paul B Beeson Career Development Award (K08AG051184) from the US National Institute on Aging and the American Federation for Aging Research. DFM reports that his institution has received funds from grants from the UK National Institute for Health Research (NIHR), Wellcome Trust, Innovate UK, and others. GDP reports funding from the NIHR in relation to the conduct of the PARAMEDIC2 trial, and support from NIHR Applied Research Collaboration West Midlands. ECG is supported by an Early Career Investigator award from the Canadian Institutes of Health Research (AR7-162822). The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources, including the NIHR and the Department of Health and Social Care. No endorsement by any of the funding agencies is intended or should be inferred.
Sources of information:
Directorio de Producción Científica
Scopus