A systematic review on quality indicators for tight glycaemic control in critically ill XXXX : need for an unambiguous indicator reference subset.

@entity1 @entity413
INTRODUCTION: The objectives of this study were to systematically identify and summarize quality indicators of tight glycaemic control in critically ill @entity1 , and to inspect the applicability of their definitions. METHODS: We searched in MEDLINE for all studies evaluating a tight glycaemic control protocol and/or quality of @entity413 control that reported original data from a clinical trial or observational study on critically ill adult @entity1 . RESULTS: Forty-nine studies met the inclusion criteria; 30 different indicators were extracted and categorized into four nonorthogonal categories: blood @entity413 zones (for example, 'hypoglycaemia'); blood @entity413 levels (for example, 'mean blood @entity413 level'); time intervals (for example, 'time to occurrence of an event'); and protocol characteristics (for example, 'blood @entity413 sampling frequency'). Hypoglycaemia-related indicators were used in 43 out of 49 studies, acting as a proxy for safety, but they employed many different definitions. Blood @entity413 level summaries were used in 41 out of 49 studies, reported as means and/or medians during the study period or at a certain time point (for example, the morning blood @entity413 level or blood @entity413 level upon starting insulin therapy). Time spent in the predefined blood @entity413 level range, time needed to reach the defined blood @entity413 level target, hyperglycaemia-related indicators and protocol-related indicators were other frequently used indicators. Most indicators differ in their definitions even when they are meant to measure the same underlying concept. More importantly, many definitions are not precise, prohibiting their applicability and hence the reproducibility and comparability of research results. CONCLUSIONS: An unambiguous indicator reference subset is necessary. The result of this systematic review can be used as a starting point from which to develop a standard list of well defined indicators that are associated with clinical outcomes or that concur with clinicians' subjective views on the quality of the regulatory process.
