How should clinicians interpret results reflecting the effect of an intervention on composite endpoints: Should I dump this lump?

Montori, Victor M.; Busse, Jason W.; Permanyer-Miralda, Gaieta; Ferreira, Ignacio; Guyatt, Gordon H.
November 2005
ACP Journal Club;Nov/Dec2005, Vol. 143 Issue 3, pA8
Academic Journal
This article presents information related to the November 2005 issue. In this issue, the ACP Journal Club highlights and comments on a landmark randomized trial, the ACHOIS trial. The ACHOIS trial was designed to determine the extent to which aggressive treatment of mild gestational diabetes affects outcomes in the mothers, induction of labor and cesarean section, and in the infants. One might justify the effort of screening and managing gestational diabetes, the higher rate of labor inductions, and the increase in neonatal nursery admissions, if the intervention reduced serious perinatal complications in the infants. Another clinical trial is ongoing in this area, and perhaps only a meta-analysis of these and other randomized controlled trials will offer sufficient data on individual outcomes to draw confident inferences about the balance between a possible reduction in perinatal deaths, and the currently much stronger evidence of an increase in induced labor and admission to a neonatal nursery.


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