Author:
Davies T. W.,van Gassel R. J. J.,van de Poll M.,Gunst J.,Casaer M. P.,Christopher K. B.,Preiser J. C.,Hill A.,Gundogan K.,Reintam-Blaser A.,Rousseau A. F.,Hodgson C.,Needham D. M.,Castro M.,Schaller S.,McClelland T.,Pilkington J. J.,Sevin C. M.,Wischmeyer P. E.,Lee Z. Y.,Govil D.,Li A.,Chapple L.,Denehy L.,Montejo-González J. C.,Taylor B.,Bear D. E.,Pearse R.,McNelly A.,Prowle J.,Puthucheary Z. A.
Abstract
Abstract
Background
Clinical research on nutritional and metabolic interventions in critically ill patients is heterogenous regarding time points, outcomes and measurement instruments used, impeding intervention development and data syntheses, and ultimately worsening clinical outcomes. We aimed to identify and develop a set of core outcome domains and associated measurement instruments to include in all research in critically ill patients.
Methods
An updated systematic review informed a two-stage modified Delphi consensus process (domains followed by instruments). Measurement instruments for domains considered ‘essential’ were taken through the second stage of the Delphi and a subsequent consensus meeting.
Results
In total, 213 participants (41 patients/caregivers, 50 clinical researchers and 122 healthcare professionals) from 24 countries contributed. Consensus was reached on time points (30 and 90 days post-randomisation). Three domains were considered ‘essential’ at 30 days (survival, physical function and Infection) and five at 90 days (survival, physical function, activities of daily living, nutritional status and muscle/nerve function). Core ‘essential’ measurement instruments reached consensus for survival and activities of daily living, and ‘recommended’ measurement instruments for physical function, nutritional status and muscle/nerve function. No consensus was reached for a measurement instrument for Infection. Four further domains met criteria for ‘recommended,’ but not ‘essential,’ to measure at 30 days post-randomisation (organ dysfunction, muscle/nerve function, nutritional status and wound healing) and three at 90 days (frailty, body composition and organ dysfunction).
Conclusion
The CONCISE core outcome set is an internationally agreed minimum set of outcomes for use at 30 and 90 days post-randomisation, in nutritional and metabolic clinical research in critically ill adults.
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine