Why is some strong evidence ignored while some weak evidence is rapidly acted upon?
Most clinicians aspire to practise evidence‐based medicine, no longer believing it acceptable to implement novel interventions simply because they “make sense” or remain untested. However, external influences, psychological factors, and misapplied statistical techniques may hinder rational decision making. Using examples from intensive care literature, we discuss why well supported therapies are not always readily adopted, while poorly supported interventions may be unduly welcomed into practice.
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- 1. Acute Respiratory Distress Syndrome Network; Brower RG, Matthay MA, Morris A, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342: 1301–1308.
- 2. Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 2016; 315: 788–800.
- 3. de Smet AM, Kluytmans JA, Cooper BS, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 2009; 360: 20–31.
- 4. Oostdijk EA, de Smet AM, Blok HE, et al. Ecological effects of selective decontamination on resistant gram‐negative bacterial colonization. Am J Respir Crit Care Med 2010; 181: 452–457.
- 5. Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med 2004; 30: 536–555.
- 6. Rivers E, Nguyen B, Havstad S, et al. Early goal‐directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345: 1368–1377.
- 7. Reddi B, Finnis M, Udy AA, et al. The relationship between the change in central venous pressure and intravenous fluid volume in patients presenting to the emergency department with septic shock. Intensive Care Med 2018; 44: 1591–1592.
- 8. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001; 345: 1359–1367.
- 9. Kavanagh BP, Nurok M. Standardized intensive care. protocol misalignment and impact misattribution. Am J Respir Crit Care Med 2016; 193: 17–22.
- 10. Peake SL, Delaney A, Bailey M, et al. Goal‐directed resuscitation for patients with early septic shock. N Engl J Med 2014; 371: 1496–1506.
- 11. NICE‐SUGAR Study Investigators; Finfer S, Chittock DR, Su SY, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009; 360: 1283–1297.
- 12. Klein Klouwenberg PM, Cremer OL, van Vught LA, et al. Likelihood of infection in patients with presumed sepsis at the time of intensive care unit admission: a cohort study. Crit Care 2015; 19: 319.
- 13. Pepper DJ, Jaswal D, Sun J, et al. Evidence underpinning the Centers for Medicare and Medicaid Services’ Severe Sepsis and Septic Shock Management Bundle (SEP‐1): a systematic review. Ann Intern Med 2018; 168: 558–568.
- 14. Ioannidis JP. Why most published research findings are false. PLoS Med 2005; 2: 696–701.
- 15. Amrhein V, Greenland S, McShane B. Scientists rise up against statistical significance. Nature 2019; 567: 305–307.
- 16. Fisher R. The design of experiments, 9th ed. London: Macmillan; 1971.
No relevant disclosures.