Determining optimal outcome measures in a trial investigating no routine gastric residual volume measurement in critically ill children

Tume, LN; Arch, B; Woolfall, K; Roper, L; Deja, E; Jones, A; Latten, L; Ecclesone, H; Hickey, H; Pathan, N; Preston, J; Beissel, A; Andrzejewska, I; Gale, C; Valla, FV; Dorling, J

Abstract

Background
Choosing trial outcome measures is important. When outcomes are not clinically relevant or important to parents/patients, trial evidence is less likely to be implemented into practice. This study aimed to determine optimal outcome measures for a trial of no routine gastric residual volume measurement in critically ill children.
Methods: A mixed methods approach: a focused literature review, parent and clinician interviews, a modified two-round Delphi and a stakeholder consensus meeting.
Results: The review generated 13 outcomes. 14 Pediatric Intensive Care Unit (PICU) parents proposed 3 additional outcomes, these 16 were then rated by 28 clinicians in Delphi round 1. Six further outcomes were proposed, and 22 outcomes were rated in the second round. No items were voted ‘consensus out’. The 18 ‘no-consensus’ items were voted in a face-to-face meeting by 30 participants. The final 12 outcome measures were: Time to reach energy targets; ventilator associated pneumonia; vomiting; time enteral feeds withheld per 24 hour; necrotizing enterocolitis; length of invasive ventilation; PICU length of stay; mortality; change in weight and markers of feed intolerance: parenteral nutrition administered; feed formula altered and changing to post-pyloric feeds all secondary to feed intolerance.
Conclusion: We have identified 12 outcomes for a trial of no gastric residual volume measurement through a multi-stage process, seeking views of parents and clinicians.
Clinical Relevancy statement: Twelve relevant outcomes have been identified for a trial of no routine gastric residual volume measurement in critically ill children.

Citation

Tume, L., Arch, B., Woolfall, K., Roper, L., Deja, E., Jones, A., …Dorling, J. (2021). Determining optimal outcome measures in a trial investigating no routine gastric residual volume measurement in critically ill children. Journal of Parenteral and Enteral Nutrition, 45(1), 79-86. https://doi.org/10.1002/jpen.1817

• Journal Article Type: Article
• Acceptance Date: Feb 10, 2020
• Online Publication Date: Mar 6, 2020
• Publication Date: Jan 29, 2021
• Deposit Date: Feb 12, 2020
• Publicly Available Date: Mar 9, 2020
• Journal: Journal of Parenteral and Enteral Nutrition
• Print ISSN: 0148-6071
• Electronic ISSN: 1941-2444
• Publisher: SAGE Publications
• Volume: 45
• Issue: 1
• Pages: 79-86
• DOI: https://doi.org/10.1002/jpen.1817
• Publisher URL: https://doi.org/10.1002/jpen.1817
• Related Public URLs: https://onlinelibrary.wiley.com/journal/19412444
• Additional Information: Projects : A Feasibility Study of no routine Gastric residual volume measurement in mechanically ventilated Infants and Children: the GASTRIC study