title: The Childhood Adenotonsillectomy Trial (CHAT): rationale, design, and challenges of a randomized controlled trial evaluating a standard surgical procedure in a pediatric population.
abstract: Each year, over 500,000 adenotonsillectomies (AT), mostly for the treatment of pediatric obstructive sleep apnea (OSA) are performed in the US in children under 15 years of age. No definitive study, however, has been yet conducted that has rigorously evaluated the effectiveness of AT for not only improving sleep disordered breathing, but also for improving clinically relevant outcomes, such as neurocognitive function, behavior, and quality of life. The Childhood Adenotonsillectomy Trial (CHAT) was designed to assess neuropsychological and health outcomes in children randomized to receive early AT (eAT) as compared to Watchful Waiting with Supportive Care (WWSC). Important secondary goals of the study are to evaluate outcomes in subgroups defined by obesity and race. This paper addresses key elements in the design and implementation of a controlled trial for a widely used "standard practice" surgical intervention in a pediatric population, that include establishment of standardized data collection procedures across sites for a wide variety of data types, establishment of equipoise, and approaches for minimizing unblinding of selected key personnel. The study framework that was established should provide a useful template for other pediatric controlled studies or other studies that evaluate surgical interventions.
authors: Division of Sleep Medicine, Harvard Medical School, Brigham and Women’s Hospital and Beth Israel Medical Center, Boston, MA 02115, USA. sredline1@partners.org
authors: Susan
authors: S
authors: Redline
authors: Raouf
authors: R
authors: Amin
authors: Dean
authors: D
authors: Beebe
authors: Ronald D
authors: RD
authors: Chervin
authors: Susan L
authors: SL
authors: Garetz
authors: Bruno
authors: B
authors: Giordani
authors: Carole L
authors: CL
authors: Marcus
authors: Renee H
authors: RH
authors: Moore
authors: Carol L
authors: CL
authors: Rosen
authors: Raanan
authors: R
authors: Arens
authors: David
authors: D
authors: Gozal
authors: Eliot S
authors: ES
authors: Katz
authors: Ronald B
authors: RB
authors: Mitchell
authors: Hiren
authors: H
authors: Muzumdar
authors: H G
authors: HG
authors: Taylor
authors: Nina
authors: N
authors: Thomas
authors: Susan
authors: S
authors: Ellenberg
mesh_terms: D000233:Adenoidectomy / Q000379:methods; D002648:Child; D002675:Child, Preschool; D006801:Humans; D018579:Patient Selection; D017286:Polysomnography; D016032:Randomized Controlled Trials as Topic / Q000379:methods* / Q000592:standards; D016037:Single-Blind Method; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D014068:Tonsillectomy / Q000379:methods; D016896:Treatment Outcome; D057832:Watchful Waiting