Evidence map›Paper›PMID 30760277›Full record

Trial reportHealth research policy and systems2019

The National Institute for Health Research Hyperacute Stroke Research Centres and the ENCHANTED trial: the impact of enhanced research infrastructure on trial metrics and patient outcomes.

Thompson G Robinson, Xia Wang, Alice C Durham, Gary A Ford, Joy Liao, Sine Littlewood, Christine Roffe, Philip White, John Chalmers, Craig S Anderson and 1 more

Registry-linked trialOpen access · goldAbstract readRandomized Controlled Trial
In one paragraph

Trial report in Health research policy and systems, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01422616 (An International Randomised Controlled Trial to Establish the Effects of Low-dose rtPA and the Effects of Early Intensive Blood Pressure Lowering in Patients With Acute Ischaemic Stroke), which is not on this map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
0.2field-weighted citation impact, top 49% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01422616 phase3completednot on this map

An International Randomised Controlled Trial to Establish the Effects of Low-dose rtPA and the Effects of Early Intensive Blood Pressure Lowering in Patients With Acute Ischaemic Stroke

TypeinterventionalSponsorThe George InstituteRan2012 to 2018Enrolled4,587ConditionsIschemic Stroke, High Blood PressureArmsLow-dose rtPA, Standard-dose rtPA, Intensive blood pressure (BP) lowering, BP management policies
3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it, 3 citations in OpenAlex.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 8 institutions in 3 countries.

Thompson G RobinsonDepartment of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom. tgr2@le.ac.uk.ORCID http://orcid.org/0000-0003-2144-2468
Xia WangThe George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Alice C DurhamDepartment of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.
Gary A FordOxford University Hospitals NHS Foundation Trust and Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.
Joy LiaoNIHR Specialty Cluster A Co-ordinating Centre, Imperial College London, London, United Kingdom.
Sine LittlewoodNIHR Clinical Research Network National Co-ordinating Centre, Leeds, United Kingdom.
Christine RoffeStroke Research in Stoke Institute for Applied Clinical Studies, Keele University, Staffordshire, United Kingdom.
Philip WhiteInstitute of Neuroscience Newcastle University and Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom.
John ChalmersThe George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Craig S AndersonThe George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
ENCHANTED Investigators
University of Leicester · GBNewcastle upon Tyne Hospital · GBNIHR Imperial Biomedical Research Centre · GBNIHR Research Delivery Network · GBPeking University · CNRoyal Prince Alfred Hospital · AUUniversity of Oxford · GBUNSW Sydney · AU

Funding

Stroke Association TSA2012/01
6 · The paper itself

Abstract

backgroundThe English National Institute for Health Research Clinical Research Network first established Hyperacute Stroke Research Centres (HSRCs) in 2010 to support multicentre hyperacute (< 9 h) and complex stroke research. We assessed the impact of this investment on research performance and patient outcomes in a post-hoc analysis of country-specific data from a large multicentre clinical trial.

methodsComparisons of baseline, outcome and trial metric data were made for participants recruited to the alteplase-dose arm of the international Enhanced Control of Hypertension and Thrombolysis Stroke study (ENCHANTED) at National Institute for Health Research Clinical Research Network HSRCs and non-HSRCs between June 2012 and October 2015.

resultsAmong 774 ENCHANTED United Kingdom participants (41% female; mean age 72 years), 502 (64.9%) were recruited from nine HSRCs and 272 (35.1%) from 24 non-HSRCs. HSRCs had higher monthly recruitment rates (median 1.5, interquartile interval 1.4-2.2 vs. 0.7, 0.5-1.3; p = 0.01) and shorter randomisation-to-treatment times (2.6 vs. 3.1 min; p = 0.01) compared to non-HSRCs. HSRC participants were younger and had milder stroke severity, but clinically important between-group differences in 90-day death or disability outcomes remained after adjustment for minimisation criteria and important baseline variables at randomisation, whether defined by ordinal modified Rankin scale score shift (adjusted OR 0.82, 95% CI 0.62-1.08; p = 0.15), scores 2 to 6 (adjusted OR 0.71, 95% CI 0.50-1.01; p = 0.05), or scores 3 to 6 (adjusted OR 0.82, 95% CI 0.57-1.17; p = 0.27). There was no significant difference in symptomatic intracerebral haemorrhage, nor heterogeneity in the comparative treatment effects between low- and standard-dose alteplase by HSRCs or non-HSRCs.

conclusionsInfrastructure investment in HSRCs was associated with improved research performance metrics, particularly recruitment and time to treatment with clinically important, though not statistically significant, improvements in patient outcomes.

trial registrationUnique identifier: NCT01422616 .

Indexed as

Academies and InstitutesAcute DiseaseAgedBiomedical ResearchCerebral HemorrhageEnglandFemaleFibrinolytic AgentsHumansHypertensionMaleMiddle AgedStrokeThrombosisTissue Plasminogen ActivatorTreatment OutcomeFibrinolytic AgentsTissue Plasminogen ActivatorAcute ischaemic strokealteplaseclinical trialssymptomatic intracerebral haemorrhagethrombolysis

Identifiers

PMID30760277
PMCPMC6375185
OpenAlexW2908925108

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.