title: Can emergency medicine research benefit from adaptive design clinical trials?
abstract: BACKGROUND
  Adaptive design clinical trials use preplanned interim analyses to determine whether studies should be stopped or modified before recruitment is complete. Emergency medicine trials are well suited to these designs as many have a short time to primary outcome relative to the length of recruitment. We hypothesised that the majority of published emergency medicine trials have the potential to use a simple adaptive trial design.
  
  
  METHODS
  We reviewed clinical trials published in three emergency medicine journals between January 2003 and December 2013. We determined the proportion that used an adaptive design as well as the proportion that could have used a simple adaptive design based on the time to primary outcome and length of recruitment.
  
  
  RESULTS
  Only 19 of 188 trials included in the review were considered to have used an adaptive trial design. A total of 154/165 trials that were fixed in design had the potential to use an adaptive design.
  
  
  CONCLUSIONS
  Currently, there seems to be limited uptake in the use of adaptive trial designs in emergency medicine despite their potential benefits to save time and resources. Failing to take advantage of adaptive designs could be costly to patients and research. It is recommended that where practical and logistical considerations allow, adaptive designs should be used for all emergency medicine clinical trials.
authors: Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors: Laura
authors: http://orcid.org/0000-0002-9569-8290
authors: L
authors: Flight
authors: Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors: Steven A
authors: SA
authors: Julious
authors: Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors: Steve
authors: S
authors: Goodacre
mesh_terms: D002986:Clinical Trials as Topic / Q000379:methods*; D004635:Emergency Medicine / Q000379:methods; D006801:Humans; D018579:Patient Selection; D012107:Research Design / Q000592:standards*
keywords: efficiency; research, methods; statistics