The Childhood Adenotonsillectomy Trial (CHAT): Rationale, design, and challenges of a randomized controlled trial evaluating a standard surgical procedure in a pediatric population

Susan Redline, Raouf Amin, Dean Beebe, Ronald D. Chervin, Susan L. Garetz, Bruno Giordani, Carole L. Marcus, Reneé H. Moore, Carol L. Rosen, Raanan Arens, David Gozal, Eliot S. Katz, Ronald B. Mitchell, Hiren Muzumdar, H. G. Taylor, Nina Thomas, Susan Ellenberg

Research output: Contribution to journalArticle

82 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1509-1517
Number of pages9
JournalSleep
Volume34
Issue number11
DOIs
StatePublished - Nov 1 2011

Keywords

  • Adenotonsillectomy
  • Clinical trial
  • Pediatrics
  • Sleep apnea

ASJC Scopus subject areas

  • Clinical Neurology
  • Physiology (medical)

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    Redline, S., Amin, R., Beebe, D., Chervin, R. D., Garetz, S. L., Giordani, B., Marcus, C. L., Moore, R. H., Rosen, C. L., Arens, R., Gozal, D., Katz, E. S., Mitchell, R. B., Muzumdar, H., Taylor, H. G., Thomas, N., & Ellenberg, S. (2011). The Childhood Adenotonsillectomy Trial (CHAT): Rationale, design, and challenges of a randomized controlled trial evaluating a standard surgical procedure in a pediatric population. Sleep, 34(11), 1509-1517. https://doi.org/10.5665/sleep.1388