Dr Alexander Mathioudakis Talks About Outcome Measurement Inconsistencies in RCTs on Pneumonia

Outcome inconsistency in randomized controlled trials for pneumonia could create issues for interpreting data and compiling research going forward, said Alexander Mathioudakis, MD, MRCP, at the European Respiratory Society annual meeting.

Outcome inconsistency in randomized controlled trials for pneumonia could create issues for interpreting data and compiling research in meta-analyses going forward, said Alexander Mathioudakis, MD, MRCP, a clinical research fellow and honorary lecturer in respiratory medicine at the University of Manchester and Manchester University NHS Foundation Trust.


How do randomized controlled trials reporting on pneumonia outcomes differ from each other and which outcomes measurements are the most commonly reported?

Mathioudakis: We have looked into the outcomes reported in trials assessing the management of community acquired pneumonia, hospital acquired pneumonia, and ventilator associated pneumonia in a systematic review that is presented in the ERS 2021 International Congress. We looked at 174 ongoing or completed randomized controlled trials, which were conducted during the last decade. And we looked at about 1400 outcomes from all these trials. More specifically, we found 72 trials looking into community acquired pneumonia predominantly, and 98 trials that looked at ventilator associated pneumonia with or without the hospital acquired pneumonia as well.

Now, in all these trials, we saw that they evaluated very diverse outcomes. And that's a big problem for a few reasons. The main reason is that many trials do not assess the outcomes that are most important to patients and other stakeholders and doctors, of course, and that makes it very difficult to interpret and use in clinical practice. And the other problem is that they are not comparable. So, it's challenging for systematic reviews and meta analyses to merge their results. And it is also very challenging for clinical practice guideline developers to develop recommendations that are strong and based on high quality evidence.

Now, the outcomes that were most frequently reported in both types of trials were mortality, treatment success or failure, and adverse events. I have to say, apart from adverse events in the community acquired pneumonia trials, which were reported in about 3 quarters of the trials, all other outcomes were not reported frequently or consistently in our studies.

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