Giuffrida Michelle A
Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.
J Am Vet Med Assoc. 2014 May 1;244(9):1075-80. doi: 10.2460/javma.244.9.1075.
To describe reporting of key methodological elements associated with type II error in published reports of small animal randomized controlled trials (RCTs) and to determine the statistical power in a subset of RCTs with negative results.
Descriptive literature survey.
Reports of parallel-group clinical RCTs published in 11 English-language veterinary journals from 2005 to 2012.
Predefined criteria were used to identify trial primary outcomes and classify results as negative or positive. Details of sample size determination and use of confidence intervals in results reporting were recorded. For each 2-group RCT with negative results, the statistical power to detect 25% and 50% relative differences in outcome was calculated.
Of 238 RCTs, 42 (18%) stated a primary outcome, 52 (22%) reported a sample size calculation, and 18 (9%) included a confidence interval around the observed treatment effect. Reports of only 2 (0.8%) RCTs included all 3 elements. Among 103 two-group RCTs with negative results, only 14 (14%) and 40 (39%) were sufficiently powered (β < 0.20) to detect 25% and 50% relative differences in outcome between treatments, respectively.
The present survey found that small animal RCTs with negative results were often underpowered to detect moderate-to-large effect sizes between study groups. Information needed for critical appraisal was missing from most reports. The potential for clinicians to base treatment decisions on inappropriate interpretations of RCTs was worrisome. Design and reporting of small animal RCTs must be improved.
描述小型动物随机对照试验(RCT)已发表报告中与II型错误相关的关键方法学要素,并确定一组结果为阴性的RCT的统计功效。
描述性文献调查。
2005年至2012年在11种英文兽医期刊上发表的平行组临床RCT报告。
使用预定义标准确定试验主要结局,并将结果分类为阴性或阳性。记录样本量确定的细节以及结果报告中置信区间的使用情况。对于每组结果为阴性的两组RCT,计算检测结局中25%和50%相对差异的统计功效。
在238项RCT中,42项(18%)陈述了主要结局,52项(22%)报告了样本量计算,18项(9%)纳入了观察到的治疗效果的置信区间。只有2项(0.8%)RCT的报告包含了所有3个要素。在103项结果为阴性的两组RCT中,分别只有14项(14%)和40项(39%)有足够的功效(β<0.20)来检测治疗组间结局25%和50%的相对差异。
本次调查发现,结果为阴性的小型动物RCT往往没有足够的功效来检测研究组之间中度至大的效应量。大多数报告缺少关键评估所需的信息。临床医生可能基于对RCT的不恰当解释做出治疗决策,这令人担忧。小型动物RCT的设计和报告必须改进。