Collider bias in trauma comparative effectiveness research: the stratification blues for systematic reviews

Injury
Deborah J Del JuncoROC Investigators

Abstract

Collider bias, or stratifying data by a covariate consequence rather than cause (confounder) of treatment and outcome, plagues randomised and observational trauma research. Of the seven trials of prehospital hypertonic saline in dextran (HSD) that have been evaluated in systematic reviews, none found an overall between-group difference in survival, but four reported significant subgroup effects. We hypothesised that an avoidable type of collider bias often introduced inadvertently into trauma comparative effectiveness research could explain the incongruous findings. The two most recent HSD trials, a single-site pilot and a multi-site pivotal study, provided data for a secondary analysis to more closely examine the potential for collider bias. The two trials had followed the a priori statistical analysis plan to subgroup patients by a post-randomisation covariate and well-established surrogate for bleeding severity, massive transfusion (MT), ≥ 10 unit of red blood cells within 24h of admission. Despite favourable HSD effects in the MT subgroup, opposite effects in the non-transfused subgroup halted the pivotal trial early. In addition to analyzing the data from the two trials, we constructed causal diagrams and performed a meta-...Continue Reading

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Citations

Aug 26, 2015·Annals of Emergency Medicine·John F KraghLorne H Blackbourne
Jul 15, 2015·Statistical Methods in Medical Research·Jing NingMei-Cheng Wang
Oct 17, 2020·Annals of Surgery·John B HolcombPampee Young
Jul 3, 2021·Trauma Surgery & Acute Care Open·AlleaBelle GongolaKyle J Kalkwarf
Jul 30, 2021·The Journal of Trauma and Acute Care Surgery·Stacy A ShackelfordSean Keenan

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