Relation Between Prepublication Release of Clinical Trial Results and the Practice of Carotid Endarterectomy

摘要: ContextLittle is known about how clinical practice affected by disseminating results of trials prior to publication in peer-reviewed journals.ObjectiveTo determine whether prepublication release carotid endarterectomy (CEA) trial results via National Institutes Health Clinical Alerts was associated with prompt changes patient care that were consistent the new medical evidence.Design, Setting, and PatientsLongitudinal data series analysis using acute hospital discharge data from the Healthcare Cost Utilization Project for patients who had CEA performed hospitals 7 states (New York, California, Pennsylvania, Florida, Colorado, Illinois, Wisconsin). The North American Symptomatic Carotid Endarterectomy Trial (NASCET alert released February 1991) Asymptomatic Atherosclerosis Study (ACAS alert released September 1994).Main Outcome MeasureCarotid endarterectomy rate during each month 1989 (2 years before the NASCET alert) 1996 after ACAS alert), adjusted age sex. Because both limited 80 years or younger low mortality, we also stratified CEA rates by mortality rate.ResultsFrom through 1996, 272,849 CEAs care hospitals these states, annual number increasing 22,300 to 51,495. After alert, adjusted increased 3.4% per (95% confidence interval [CI], 1.6%-5.3%) following 6 months then increased 0.5% CI, 0.2%-0.8%; P<.04) journal study. the ACAS 7.3% 6.0%-8.5%) during following decreased 0.44% −0.86% to −0.0002%; publication of more in aged 80 older than patients; whereas, after journal ACAS, more rapidly older population. overall proportion low-mortality hospitals did not change substantially alerts publication.ConclusionIn this study, dissemination with clinical was associated substantial medical practice, but observed suggest extrapolated to settings directly supported trials.