The randomized trial, alone or as part of a meta-analysis, is the pinnacle of the evidence pyramid.1 Rigorously performed randomized trials offer key insights into the benefit of a treatment vs a control or of a new treatment compared with a standard treatment, although clinicians do not always adopt trial findings into practice. The resulting practice variability is inherent to the art of medicine but not always to the benefit of patients.
Walter KL, Seymour CW. Hydrocortisone, Vitamin C, and Thiamine for Treatment of Sepsis: Making Evidence Matter. JAMA. 2021;325(8):730–731. doi:10.1001/jama.2020.26029
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