Co-enrollment of critically ill patients into multiple studies: patterns, predictors and consequences

Deborah Cook, Ellen McDonald, Orla Smith, Nicole Zytaruk, Diane Heels-Ansdell, Irene Watpool, Tracy McArdle, Andrea Matte, France Clarke, Shirley Vallance, Simon Finfer, Pauline Galt, Tim M E Crozier, Rob Fowler, Yaseen Arabi, Clive Woolfe, Neil Orford, Richard Hall, Neill KJ Adhikari, Marie-Clauide Ferland & 2 others John Marshall, Maureen Meade

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13 Citations (Scopus)

Abstract

Research on co-enrollment practices and their impact are limited in the ICU setting. The objectives of this study were: 1) to describe patterns and predictors of co-enrollment of patients in a thromboprophylaxis trial, and 2) to examine the consequences of co-enrollment on clinical and trial outcomes.Methods: In an observational analysis of an international thromboprophylaxis trial in 67 ICUs, we examined the co-enrollment of critically ill medical-surgical patients into more than one study, and examined the clinical and trial outcomes among co-enrolled and non-co-enrolled patients.Results: Among 3,746 patients enrolled in PROTECT (Prophylaxis for ThromboEmbolism in Critical Care Trial), 713 (19.0 ) were co-enrolled in at least one other study (53.6 in a randomized trial, 37.0 in an observational study and 9.4 in both). Six factors independently associated with co-enrollment (all P <0.001) were illness severity (odds ratio (OR) 1.35, 95 confidence interval (CI) 1.19 to 1.53 for each 10-point Acute Physiology and Chronic Health Evaluation (APACHE) II score increase), substitute decision-makers providing consent, rather than patients (OR 3.31, 2.03 to 5.41), experience of persons inviting consent (OR 2.67, 1.74 to 4.11 for persons with > 10 years experience compared to persons with none), center size (all ORs > 10 for ICUs with > 15 beds), affiliation with trials groups (OR 5.59, 3.49 to 8.95), and main trial rather than pilot phase (all ORs > 8 for recruitment year beyond the pilot). Co-enrollment did not influence clinical or trial outcomes or risk of adverse events.Conclusions: Co-enrollment was strongly associated with features of the patients, research personnel, setting and study. Co-enrollment had no impact on trial results, and appeared safe, acceptable and feasible. Transparent reporting, scholarly discourse, ethical analysis and further research are needed on the complex topic of co-enrollment during critical illness.
Original languageEnglish
Pages (from-to)1 - 11
Number of pages11
JournalCritical Care
Volume17
Issue number1 (Art. No.: R1)
DOIs
Publication statusPublished - 2013

Cite this

Cook, D., McDonald, E., Smith, O., Zytaruk, N., Heels-Ansdell, D., Watpool, I., ... Meade, M. (2013). Co-enrollment of critically ill patients into multiple studies: patterns, predictors and consequences. Critical Care, 17(1 (Art. No.: R1)), 1 - 11. https://doi.org/10.1186/cc11917
Cook, Deborah ; McDonald, Ellen ; Smith, Orla ; Zytaruk, Nicole ; Heels-Ansdell, Diane ; Watpool, Irene ; McArdle, Tracy ; Matte, Andrea ; Clarke, France ; Vallance, Shirley ; Finfer, Simon ; Galt, Pauline ; Crozier, Tim M E ; Fowler, Rob ; Arabi, Yaseen ; Woolfe, Clive ; Orford, Neil ; Hall, Richard ; Adhikari, Neill KJ ; Ferland, Marie-Clauide ; Marshall, John ; Meade, Maureen. / Co-enrollment of critically ill patients into multiple studies: patterns, predictors and consequences. In: Critical Care. 2013 ; Vol. 17, No. 1 (Art. No.: R1). pp. 1 - 11.
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title = "Co-enrollment of critically ill patients into multiple studies: patterns, predictors and consequences",
abstract = "Research on co-enrollment practices and their impact are limited in the ICU setting. The objectives of this study were: 1) to describe patterns and predictors of co-enrollment of patients in a thromboprophylaxis trial, and 2) to examine the consequences of co-enrollment on clinical and trial outcomes.Methods: In an observational analysis of an international thromboprophylaxis trial in 67 ICUs, we examined the co-enrollment of critically ill medical-surgical patients into more than one study, and examined the clinical and trial outcomes among co-enrolled and non-co-enrolled patients.Results: Among 3,746 patients enrolled in PROTECT (Prophylaxis for ThromboEmbolism in Critical Care Trial), 713 (19.0 ) were co-enrolled in at least one other study (53.6 in a randomized trial, 37.0 in an observational study and 9.4 in both). Six factors independently associated with co-enrollment (all P <0.001) were illness severity (odds ratio (OR) 1.35, 95 confidence interval (CI) 1.19 to 1.53 for each 10-point Acute Physiology and Chronic Health Evaluation (APACHE) II score increase), substitute decision-makers providing consent, rather than patients (OR 3.31, 2.03 to 5.41), experience of persons inviting consent (OR 2.67, 1.74 to 4.11 for persons with > 10 years experience compared to persons with none), center size (all ORs > 10 for ICUs with > 15 beds), affiliation with trials groups (OR 5.59, 3.49 to 8.95), and main trial rather than pilot phase (all ORs > 8 for recruitment year beyond the pilot). Co-enrollment did not influence clinical or trial outcomes or risk of adverse events.Conclusions: Co-enrollment was strongly associated with features of the patients, research personnel, setting and study. Co-enrollment had no impact on trial results, and appeared safe, acceptable and feasible. Transparent reporting, scholarly discourse, ethical analysis and further research are needed on the complex topic of co-enrollment during critical illness.",
author = "Deborah Cook and Ellen McDonald and Orla Smith and Nicole Zytaruk and Diane Heels-Ansdell and Irene Watpool and Tracy McArdle and Andrea Matte and France Clarke and Shirley Vallance and Simon Finfer and Pauline Galt and Crozier, {Tim M E} and Rob Fowler and Yaseen Arabi and Clive Woolfe and Neil Orford and Richard Hall and Adhikari, {Neill KJ} and Marie-Clauide Ferland and John Marshall and Maureen Meade",
year = "2013",
doi = "10.1186/cc11917",
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volume = "17",
pages = "1 -- 11",
journal = "Critical Care",
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Cook, D, McDonald, E, Smith, O, Zytaruk, N, Heels-Ansdell, D, Watpool, I, McArdle, T, Matte, A, Clarke, F, Vallance, S, Finfer, S, Galt, P, Crozier, TME, Fowler, R, Arabi, Y, Woolfe, C, Orford, N, Hall, R, Adhikari, NKJ, Ferland, M-C, Marshall, J & Meade, M 2013, 'Co-enrollment of critically ill patients into multiple studies: patterns, predictors and consequences', Critical Care, vol. 17, no. 1 (Art. No.: R1), pp. 1 - 11. https://doi.org/10.1186/cc11917

Co-enrollment of critically ill patients into multiple studies: patterns, predictors and consequences. / Cook, Deborah; McDonald, Ellen; Smith, Orla; Zytaruk, Nicole; Heels-Ansdell, Diane; Watpool, Irene; McArdle, Tracy; Matte, Andrea; Clarke, France; Vallance, Shirley; Finfer, Simon; Galt, Pauline; Crozier, Tim M E; Fowler, Rob; Arabi, Yaseen; Woolfe, Clive; Orford, Neil; Hall, Richard; Adhikari, Neill KJ; Ferland, Marie-Clauide; Marshall, John; Meade, Maureen.

In: Critical Care, Vol. 17, No. 1 (Art. No.: R1), 2013, p. 1 - 11.

Research output: Contribution to journalArticleOther

TY - JOUR

T1 - Co-enrollment of critically ill patients into multiple studies: patterns, predictors and consequences

AU - Cook, Deborah

AU - McDonald, Ellen

AU - Smith, Orla

AU - Zytaruk, Nicole

AU - Heels-Ansdell, Diane

AU - Watpool, Irene

AU - McArdle, Tracy

AU - Matte, Andrea

AU - Clarke, France

AU - Vallance, Shirley

AU - Finfer, Simon

AU - Galt, Pauline

AU - Crozier, Tim M E

AU - Fowler, Rob

AU - Arabi, Yaseen

AU - Woolfe, Clive

AU - Orford, Neil

AU - Hall, Richard

AU - Adhikari, Neill KJ

AU - Ferland, Marie-Clauide

AU - Marshall, John

AU - Meade, Maureen

PY - 2013

Y1 - 2013

N2 - Research on co-enrollment practices and their impact are limited in the ICU setting. The objectives of this study were: 1) to describe patterns and predictors of co-enrollment of patients in a thromboprophylaxis trial, and 2) to examine the consequences of co-enrollment on clinical and trial outcomes.Methods: In an observational analysis of an international thromboprophylaxis trial in 67 ICUs, we examined the co-enrollment of critically ill medical-surgical patients into more than one study, and examined the clinical and trial outcomes among co-enrolled and non-co-enrolled patients.Results: Among 3,746 patients enrolled in PROTECT (Prophylaxis for ThromboEmbolism in Critical Care Trial), 713 (19.0 ) were co-enrolled in at least one other study (53.6 in a randomized trial, 37.0 in an observational study and 9.4 in both). Six factors independently associated with co-enrollment (all P <0.001) were illness severity (odds ratio (OR) 1.35, 95 confidence interval (CI) 1.19 to 1.53 for each 10-point Acute Physiology and Chronic Health Evaluation (APACHE) II score increase), substitute decision-makers providing consent, rather than patients (OR 3.31, 2.03 to 5.41), experience of persons inviting consent (OR 2.67, 1.74 to 4.11 for persons with > 10 years experience compared to persons with none), center size (all ORs > 10 for ICUs with > 15 beds), affiliation with trials groups (OR 5.59, 3.49 to 8.95), and main trial rather than pilot phase (all ORs > 8 for recruitment year beyond the pilot). Co-enrollment did not influence clinical or trial outcomes or risk of adverse events.Conclusions: Co-enrollment was strongly associated with features of the patients, research personnel, setting and study. Co-enrollment had no impact on trial results, and appeared safe, acceptable and feasible. Transparent reporting, scholarly discourse, ethical analysis and further research are needed on the complex topic of co-enrollment during critical illness.

AB - Research on co-enrollment practices and their impact are limited in the ICU setting. The objectives of this study were: 1) to describe patterns and predictors of co-enrollment of patients in a thromboprophylaxis trial, and 2) to examine the consequences of co-enrollment on clinical and trial outcomes.Methods: In an observational analysis of an international thromboprophylaxis trial in 67 ICUs, we examined the co-enrollment of critically ill medical-surgical patients into more than one study, and examined the clinical and trial outcomes among co-enrolled and non-co-enrolled patients.Results: Among 3,746 patients enrolled in PROTECT (Prophylaxis for ThromboEmbolism in Critical Care Trial), 713 (19.0 ) were co-enrolled in at least one other study (53.6 in a randomized trial, 37.0 in an observational study and 9.4 in both). Six factors independently associated with co-enrollment (all P <0.001) were illness severity (odds ratio (OR) 1.35, 95 confidence interval (CI) 1.19 to 1.53 for each 10-point Acute Physiology and Chronic Health Evaluation (APACHE) II score increase), substitute decision-makers providing consent, rather than patients (OR 3.31, 2.03 to 5.41), experience of persons inviting consent (OR 2.67, 1.74 to 4.11 for persons with > 10 years experience compared to persons with none), center size (all ORs > 10 for ICUs with > 15 beds), affiliation with trials groups (OR 5.59, 3.49 to 8.95), and main trial rather than pilot phase (all ORs > 8 for recruitment year beyond the pilot). Co-enrollment did not influence clinical or trial outcomes or risk of adverse events.Conclusions: Co-enrollment was strongly associated with features of the patients, research personnel, setting and study. Co-enrollment had no impact on trial results, and appeared safe, acceptable and feasible. Transparent reporting, scholarly discourse, ethical analysis and further research are needed on the complex topic of co-enrollment during critical illness.

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DO - 10.1186/cc11917

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JO - Critical Care

JF - Critical Care

SN - 1364-8535

IS - 1 (Art. No.: R1)

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Cook D, McDonald E, Smith O, Zytaruk N, Heels-Ansdell D, Watpool I et al. Co-enrollment of critically ill patients into multiple studies: patterns, predictors and consequences. Critical Care. 2013;17(1 (Art. No.: R1)):1 - 11. https://doi.org/10.1186/cc11917