Academic and Community ICUs Participating in a Critical Care Randomized Trial: A Comparison of Patient Characteristics and Trial Metrics

Jennifer L Y Tsang^{1

2}, Alexandra Binnie^{3

4}, Erick H Duan^{1

2

5}, Jennie Johnstone^{6

7}, Diane Heels-Ansdell⁸, Brenda Reeve⁹, Sebastien Trop³, Paul Hosek¹⁰, Joanna C Dionne^{2

8

11}, Patrick Archambault¹², Paul Lysecki¹³, Robert Cirone¹⁴, Nicole L Zytaruk^{5

8}, William Dechert⁹, Mercedes Peñuela Camargo¹, Rebecca Jesso¹⁰, Elliot McMillan¹⁰, Zaynab Panchbhaya³, Tracy Campbell¹³, Lois Saunders⁵, Mary Copland⁵, Kanthi Kavikondala¹⁴, Deborah J Cook^{2

5

8}

Affiliations

¹ Division of Critical Care, Department of Medicine, Niagara Health, St. Catharines, ON, Canada.
² Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.
³ Department of Critical Care, William Osler Health System, Brampton, ON, Canada.
⁴ Faculty of Medicine and Biomedical Sciences, University of Algarve, Algarve Biomedical Centre, Faro, Portugal.
⁵ Department of Medicine, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
⁶ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
⁷ Department of Infection Prevention and Control, Sinai Health, Toronto, ON, Canada.
⁸ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
⁹ Division of Critical Care, Brantford General Hospital, Brantford, ON, Canada.
¹⁰ Division of Critical Care, Grand River Hospital, Kitchener, ON, Canada.
¹¹ Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
¹² Department of Emergency Medicine, Hôtel-Dieu de Lévis, Lévis, QC, Canada.
¹³ Department of Medicine, Joseph Brant Hospital, Burlington, ON, Canada.
¹⁴ Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.

PMID: 36419633
PMCID: PMC9678527
DOI: 10.1097/CCE.0000000000000794

Academic and Community ICUs Participating in a Critical Care Randomized Trial: A Comparison of Patient Characteristics and Trial Metrics

Jennifer L Y Tsang et al. Crit Care Explor. 2022.

. 2022 Nov 18;4(11):e0794.

doi: 10.1097/CCE.0000000000000794. eCollection 2022 Nov.

Authors

Affiliations

¹ Division of Critical Care, Department of Medicine, Niagara Health, St. Catharines, ON, Canada.
² Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.
³ Department of Critical Care, William Osler Health System, Brampton, ON, Canada.
⁴ Faculty of Medicine and Biomedical Sciences, University of Algarve, Algarve Biomedical Centre, Faro, Portugal.
⁵ Department of Medicine, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
⁶ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
⁷ Department of Infection Prevention and Control, Sinai Health, Toronto, ON, Canada.
⁸ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
⁹ Division of Critical Care, Brantford General Hospital, Brantford, ON, Canada.
¹⁰ Division of Critical Care, Grand River Hospital, Kitchener, ON, Canada.
¹¹ Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
¹² Department of Emergency Medicine, Hôtel-Dieu de Lévis, Lévis, QC, Canada.
¹³ Department of Medicine, Joseph Brant Hospital, Burlington, ON, Canada.
¹⁴ Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.

PMID: 36419633
PMCID: PMC9678527
DOI: 10.1097/CCE.0000000000000794

Abstract

Clinical research in Canada is conducted primarily in "academic" hospitals, whereas most clinical care is provided in "community" hospitals. The objective of this nested observational study was to compare patient characteristics, outcomes, process-of-care variables, and trial metrics for patients enrolled in a large randomized controlled trial who were admitted to academic and community hospitals in Canada.

Design: We conducted a preplanned observational study nested within the Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT, a randomized controlled trial comparing probiotics to placebo in mechanically ventilated patients) Research Program.

Setting: ICUs.

Patients: Mechanically ventilated patients.

Measurements: We compared patient characteristics, interventions, outcomes, and trial metrics between patients enrolled in PROSPECT from academic and community hospitals.

Main results: Participating centers included 34 (82.9%) academic and seven (17.1%) community hospitals, which enrolled 2,203 (86.2%) and 352 (13.8%) patients, respectively. Compared with academic hospitals, patients enrolled in community hospitals were older (mean [sd] 62.7 yr [14.9 yr] vs 59.5 yr [16.4 yr]; p = 0.044), had longer ICU stays (median [interquartile range {IQR}], 13 d [8-23 d] vs 11 d [7-8 d]; p = 0.012) and higher mortality (percentage, [95% CI] in the ICU, 30.4% [25.8-35.4%]vs 20.5% [18.9-11.3%]; p = 0.002) and hospital (40.6% [35.6-45.8%] vs 26.1% [24.3-27.9%]; p < 0.001). Trial metrics, including informed consent rate (85.9% vs 76.3%; p = 0.149), mean (sd) monthly enrolment rate (2.1 [1.4] vs 1.1 [0.7]; p = 0.119), and protocol adherence (90.6% vs 91.6%; p = 0.207), were similar between community and academic ICUs.

Conclusions: Community hospitals can conduct high-quality research, with similar trial metrics to academic hospitals. Patient characteristics differed between community and academic hospitals, highlighting the need for broader engagement of community hospitals in clinical research to ensure generalizability of study results.

Keywords: academic hospitals; community hospitals; critical care; intensive care; randomized controlled trials.

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Conflict of interest statement

The Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial Trial was funded by the Canadian Institutes of Health Research Research Grant. Dr. Tsang is supported by a Mid-Career Research Award of the McMaster University Department of Medicine. Dr. Cook is supported by a Canada Research Chair of the Canadian Institutes for Health Research. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

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Academic and Community ICUs Participating in a Critical Care Randomized Trial: A Comparison of Patient Characteristics and Trial Metrics

Affiliations

Academic and Community ICUs Participating in a Critical Care Randomized Trial: A Comparison of Patient Characteristics and Trial Metrics

Authors

Affiliations

Abstract

Conflict of interest statement

References

LinkOut - more resources

Full Text Sources