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Open Access 01-12-2011 | Research

Between-centre differences and treatment effects in randomized controlled trials: A case study in traumatic brain injury

Authors: Hester F Lingsma, Bob Roozenbeek, Pablo Perel, Ian Roberts, Andrew IR Maas, Ewout W Steyerberg

Published in: Trials | Issue 1/2011

Abstract

Background

In Traumatic Brain Injury (TBI), large between-centre differences in outcome exist and many clinicians believe that such differences influence estimation of the treatment effect in randomized controlled trial (RCTs). The aim of this study was to assess the influence of between-centre differences in outcome on the estimated treatment effect in a large RCT in TBI.

Methods

We used data from the MRC CRASH trial on the efficacy of corticosteroid infusion in patients with TBI. We analyzed the effect of the treatment on 14 day mortality with fixed effect logistic regression. Next we used random effects logistic regression with a random intercept to estimate the treatment effect taking into account between-centre differences in outcome. Between-centre differences in outcome were expressed with a 95% range of odds ratios (OR) for centres compared to the average, based on the variance of the random effects (tau²). A random effects logistic regression model with random slopes was used to allow the treatment effect to vary by centre. The variation in treatment effect between the centres was expressed in a 95% range of the estimated treatment ORs.

Results

In 9978 patients from 237 centres, 14-day mortality was 19.5%. Mortality was higher in the treatment group (OR = 1.22, p = 0.00010). Using a random effects model showed large between-centre differences in outcome (95% range of centre effects: 0.27- 3.71), but did not substantially change the estimated treatment effect (OR = 1.24, p = 0.00003). There was limited, although statistically significant, between-centre variation in the treatment effect (OR = 1.22, 95% treatment OR range: 1.17-1.26).

Conclusion

Large between-centre differences in outcome do not necessarily affect the estimated treatment effect in RCTs, in contrast to current beliefs in the clinical area of TBI.

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Title: Between-centre differences and treatment effects in randomized controlled trials: A case study in traumatic brain injury
Authors: Hester F Lingsma
Bob Roozenbeek
Pablo Perel
Ian Roberts
Andrew IR Maas
Ewout W Steyerberg
Publication date: 01-12-2011
Publisher: BioMed Central
Published in: Trials / Issue 1/2011
Electronic ISSN: 1745-6215
DOI: https://doi.org/10.1186/1745-6215-12-201

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Between-centre differences and treatment effects in randomized controlled trials: A case study in traumatic brain injury

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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