均衡的复苏和早期死亡终点:对PROPPR试验的贝叶斯后期分析
Daniel Lammers1, Omar Rokayak1, Rindi Uhlich1
1Division of Trauma and Acute Care Surgery, The University of Alabama at Birmingham Hospital, Birmingham, Alabama, USA.
Trauma surgery & acute care open
|August 14, 2023
概括
一个1:1:1平衡的复苏策略显示出高概率的死亡率的好处在出血患者与1:1:2比率相比,特别是在早期的时间点. 这一发现支持在未来的创伤试验中使用均衡输血和贝叶斯分析.
科学领域:
- 创伤和紧急医疗医学
- 关键的护理关键的护理
- 贝叶斯统计学贝叶斯统计学
背景情况:
- 实用随机化最佳血小板和血比率 (PROPPR) 试验没有发现24小时30天后1:1:1和1:1:2血比率之间的死亡率有显著差异.
- 最近的指导方针主张在出血控制试验中使用较早的死亡终点和当代的统计方法.
研究的目的:
- 使用贝叶斯框架对PROPPR试验进行后期分析.
- 评估均衡的 (1:1:1) 与1:1:2复苏策略对早期死亡率的影响.
主要方法:
- 用贝叶斯的层次模型来评估死亡率差异.
- 在1,3,6,12,18和24小时的复苏后,分析了死亡率.
- 计算后期概率和贝叶斯因子来量化证据.
主要成果:
- 1:1:1复苏策略显示,在所有早期时间点 (92-99%) 中,死亡率益处的概率很高.
- 贝叶斯系数在11.4到142之间,表明支持1:1:1比率的有力至决定性的证据.
- 特别是在早期评估的时间点观察到显著的好处.
结论:
- 1:1:1的复苏策略可能会在出血患者中比1:1:2的策略提供死亡率的好处.
- 贝叶斯分析和早期死亡终点建议用于未来的出血控制试验.
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