The following is a summary of “Exploring the Impact of Age, Frailty, and Multimorbidity on the Effect of ICU Interventions: A Systematic Review of Randomized Controlled Trials,” published in the April 2024 issue of Critical Care by Perrella et al.
Researchers conducted a retrospective study to investigate whether age, frailty, and multimorbidity influence how older adults respond to critical care interventions and treatment outcomes.
They systematically searched top general medicine and critical care journals for RCTs investigating essential interventions of care (January 1, 2011, to December 31, 2021). RCTs included those examining age, frailty, or multimorbidity subgroups. Cluster RCTs and studies not reporting ICU interventions or subgroup data were excluded. Characteristics like single vs. multicountry enrollment, funding, sample size, and primary and secondary outcomes were collected. Population details were noted, including inclusion criteria and average age in intervention and comparator groups. The credibility of subgroup findings was assessed using the Instrument for evaluating the Credibility of Effect Modification Analyses instrument.
The results showed that out of 2,037 unique citations, 48 RCTs, with 50,779 participants, were included. Seven RCTs (14.6%) detected statistically significant effect modification based on age, while none of the multimorbidity or frailty subgroups showed significant subgroup effects. Subgroup credibility varied from very low to moderate.
Investigators found limited evaluation of frailty and multimorbidity in critical care RCTs, highlighting the need for future studies targeting these factors alongside age to optimize treatment decisions for critically ill older adults.
Source: journals.lww.com/ccmjournal/abstract/9900/exploring_the_impact_of_age,_frailty,_and.331.aspx