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Acetaminophen for Fever in Critically Ill Patients with Suspected Infection

Methodology Score: 4/5                 
Usefulness Score: 2/5

Young P, Saxena M, Bellomo R, et al.
N Engl J Med. 2015 Oct 5. 


This multicentre, ICU RCT received a methodology score of 4/5 and 2/5 for usefulness. They concluded that early treatment of fever with acetaminophen in suspected or confirmed infection results in moderate reduction in temperature, but does not affect the number of ICU-free days which was a composite endpoint combining mortality and ICU length of stay. Also, there was no statistically significant difference between acetaminophen versus placebo with respect to 28d mortality, 90d mortality, or survival time to day 90.  
By: Dr. Gauri Ghate
(Presented December 2015)

Epi Lesson: Adjustment of Confidence Intervals for Interim Analyses
Interim analyses are commonly planned in large studies. This can be useful, for example, to ensure patient safety (either by finding a significant benefit or harm early on), or as a cost saving measure by stopping the study early if there is no statistical probability to find a difference between groups later on. There are caveats to interim analyses. It is possible for a perceived “futile” study to become significant if allowed to continue on (lack of power to find a difference early on). It is also possible to find a significant difference early on by chance alone. Because the likelihood to find a difference by chance alone increases every time you analyze the data, there are strategies to account for this (such as the O’Brien Fleming Approach), most of which include raising the bar for statistical significance (i.e. p-value much smaller than 0.05 or using >95%CI instead).  
By: Dr. Christian Vaillancourt


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