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Cluster trials read differently to individual ones

Cluster Versus Individual Randomization in Prehospital, Emergency and Critical Care Trials: A Meta-Epidemiological Study
Critical Care Medicine · 2026-10-21 · Added 24 October 2026

Meta-epidemiological study of 65 meta-analyses (212 trials, 315,276 patients) comparing cluster-randomised with individually randomised trials in prehospital, emergency and critical care — no difference in mortality effect estimates, but cluster trials reported significantly smaller effect sizes for length-of-stay-type outcomes.

Study type

Systematic review

Design

Meta-epidemiological study of meta-analyses

Participants

65 meta-analyses, 212 RCTs (39 cluster), 315,276 patients

Main finding

No statistically significant difference in mortality effect estimates between cluster and individually randomised trials (MD lnOR −0.110, 95% CI −0.093 to 0.313); cluster trials showed significantly smaller effect magnitudes for length-of-stay/days-alive outcomes (Hedges' g MD −0.202, 95% CI −0.392 to −0.012)

Caveat

Observational comparison across heterogeneous meta-analyses with only 44.7% of eligible meta-analyses reporting randomisation type

Bottom line

Context only

Learning goal

Understand how cluster randomised trials differ in design and how that shapes interpreting prehospital evidence.

More

• Topic: Other
• Daily scan: 24 October 2026

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