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Review article
Available online 6 February 2025
Quality of causality assessment among observational studies in intensive care: A methodological review
Calidad de la evaluación de la causalidad en estudios observacionales en cuidados intensivos: una revisión metodológica
Laura Del Campo-Albendeaa,b,c,&#¿;
Corresponding author
lcampo@salud.madrid.org

Corresponding author.
, Ana García De La Santa Viñuelad, Óscar Peñuelase, José Ignacio Pijoan Zubizarretab,f, Khalid Saeed Khanb,g, Alfonso Muriela,b,h,, Javier Zamoraa,b,i,
a Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
b CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain
c Escuela de Doctorado UAM, Universidad Autónoma de Madrid, Madrid, Spain
d Preventive Medicine and Public Health Service, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
e Intensive Care Unit, University Hospital of Getafe, Biomedical Research Networking Center for Respiratory Diseases, CIBERES, Madrid, Spain
f Department of Epidemiology, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
g Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
h Nursing and Physiotherapy Department, University of Alcalá, Madrid, Spain
i Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
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Received 08 April 2024. Accepted 06 November 2024
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Table 1. Characteristics of included articles the methodological review of causality assessment among observational studies in intensive care.
Table 2. Frequency of words used to link exposure with outcome according to the statistical significance in title and objective sections of the articles included in the methodological review of causality assessment among observational studies in intensive care.
Table 3. Key causality items according to the instrument developed in the methodological review of causality assessment among observational studies in intensive care.
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Abstract

Intensive care units (ICUs) rely in many instances on observational research and often encounter difficulties in establishing cause-and-effect relationships. After conducting a thorough search focused on ICU observational studies, this review analysed the causal language and evaluated the quality of reporting of the methodologies employed. The causal was assessed by analysing the words linking exposure to outcomes in the title and main objective. The quality of the reporting of the key methodological aspects related to causal inference was based on STROBE and ROBINS-I tools. We identified 139 articles, with 87 (63%) and 82 (59%) studies having non-causal language in their title and main objective, respectively. Among the total, 49 (35%) articles directly addressed causality. The review found vague causal language in observational ICU research and highlighted the need for better adherence to reporting guidelines for improved causal analysis and inference.

Keywords:
Causality
Methodological review
Critical care
Observational studies
Abbreviations:
ICU
RCT
DAG
ITS
IV
MSM
CCU
ATE
ATT
ATU
Resumen

Las unidades de cuidados intensivos (UCI) dependen en muchas ocasiones de la investigación observacional y, a menudo, encuentran dificultades para establecer relaciones causales. Después de realizar una búsqueda exhaustiva de estudios observacionales en UCI, se analizó el lenguaje causal mediante el análisis de las palabras que vinculan la exposición a los resultados en el título y objetivo principal. La calidad del reporte de los aspectos metodológicos claves relacionados con la inferencia causal se evaluó utilizando las herramientas STROBE y ROBINS-I. Identificamos 139 artículos, con 87 (63%) y 82 (59%) estudios que usaban lenguaje no causal en su título y objetivo principal, respectivamente. De estos, 49 (35%) artículos abordaron directamente causalidad. La revisión encontró un uso vago de lenguaje causal en la investigación observacional en UCI y resaltó la necesidad de mejorar la adherencia a las guías de reporte para mejorar la investigación causal.

Palabras clave:
Causalidad
Revisión metodológica
Cuidados críticos
Estudios observacionales

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