S133 A core outcome set for mechanical ventilation trials: the covent study
Bibliographic record
Abstract
There is inconsistency in the selection and measurement of outcomes in clinical trials of mechanically ventilated critically ill patients.1 This presents challenges when comparing trials, and particularly when undertaking meta-analysis of trial data. A core outcome set (COS) is a minimum set of standardised outcomes that should be reported in every trial of a specific intervention. We therefore aimed to develop a COS for use in future trials where the aim of the intervention is to modify the duration of mechanical ventilation. Mixed consensus methods were used to develop this COS. A large, international, online Delphi study was followed by 2 consensus webinars with representatives from the Delphi panel and additional input from a separate patient representative group teleconference. Participants were recruited via international trials groups, critical care societies, charities and associations. Additional researchers were identified through a PubMed search. Participants represented 4 main stakeholder groups; patients, clinicians, researchers and industry. The study was conducted between December 2015 and October 2016. The Delphi ran over 3 rounds; Round 1 included 24 outcomes obtained from a systematic review. During this round a further 23 outcomes were proposed and added by participants. Numbers of participants completing each round were 200, 178 and 161 respectively. A total of 19 outcomes gained consensus through the Delphi process and were discussed at the consensus webinars and the patient teleconference. The outcomes in the final COS were agreed across all 3 meetings and included mortality, health-related quality of life, duration of mechanical ventilation, reintubation, length of stay and successful extubation (Table 1). Using robust consensus methodology this COS has been developed for use in all trials and systematic reviews evaluating interventions that may reduce the duration of mechanical ventilation. Agreement now needs to be reached on how these outcomes should be measured and defined. Reference Blackwood B, Clarke M, McAuley DF, McGuigan PJ, Marshall JC, Rose L. How outcomes are defined in clinical trials of mechanically ventilated adults and children. American Journal of Respiratory and Critical Care Medicine 2014, Apr 15;189(8):886.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.297 | 0.574 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.011 |
| Bibliometrics | 0.008 | 0.009 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.009 | 0.006 |
| Open science | 0.003 | 0.006 |
| Research integrity | 0.006 | 0.004 |
| Insufficient payload (model declined to judge) | 0.037 | 0.006 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; the direct Gemma label and the distilled Codex classifier agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".