SynthesisPsychiatry and clinical neurosciences2025
Potential placebo bias in current trials of delirium prevention: a network meta-analysis of 86 randomized controlled trials.
Synthesis in Psychiatry and clinical neurosciences, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Authors and funding
9 authors.
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Abstract
aimNumerous network meta-analyses (NMAs) have reported inconsistent findings on the efficacy of various pharmacologic treatments for delirium prevention in high-risk patients. A potential confounder was the study design-using a placebo control or standard-of-care (SoC) control. We reexamined the incident delirium between SoC plus placebo and SoC alone in randomized controlled trials (RCTs) on delirium prevention.
methodsWe systematically searched for relevant RCTs on pharmacotherapies for delirium prevention from the inception of electronic databases through 30 November 2023. The primary outcome was delirium incidence, with secondary consideration given to all-cause mortality. We conducted a frequentist NMA using risk ratios (RRs) with 95% confidence intervals (CIs) as the effect size.
resultsThe NMA results from 86 RCTs (19,889 participants, with a mean age of 68.5 years, and a mean female proportion of 44.0%) revealed that SoC plus placebo was associated with a lower risk of incident delirium than SoC alone (RR, 0.60 [95% CI, 0.41-0.88]). The RR of all-cause mortality was not significant between these two study designs.
conclusionWe found placebo effects on the incidence of delirium in RCTs involving high-risk patients. Further RCTs should consider a three-arm, parallel design including both a placebo group and an SoC group to replicate our study findings.
trial registrationCRD42023488481.
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