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非显著结果的临床试验中置信区间的解读:系统评价与建议

Interpretation of CIs in clinical trials with non-significant results: systematic review and recommendations.

作者信息

Gewandter Jennifer S, McDermott Michael P, Kitt Rachel A, Chaudari Jenna, Koch James G, Evans Scott R, Gross Robert A, Markman John D, Turk Dennis C, Dworkin Robert H

机构信息

Department of Anesthesiology, University of Rochester, Rochester, New York, USA.

Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA.

出版信息

BMJ Open. 2017 Jul 18;7(7):e017288. doi: 10.1136/bmjopen-2017-017288.

Abstract

OBJECTIVES

Interpretation of CIs in randomised clinical trials (RCTs) with treatment effects that are not statistically significant can distinguish between results that are 'negative' (the data are not consistent with a clinically meaningful treatment effect) or 'inconclusive' (the data remain consistent with the possibility of a clinically meaningful treatment effect). This interpretation is important to ensure that potentially beneficial treatments are not prematurely abandoned in future research or clinical practice based on invalid conclusions.

DESIGN

Systematic review of RCT reports published in 2014 in , , , and (n=247).

RESULTS

85 of 99 articles with statistically non-significant results reported CIs for the treatment effect. Only 17 of those 99 articles interpreted the CI. Of the 22 articles in which CIs indicated an inconclusive result, only four acknowledged that the study could not rule out a clinically meaningful treatment effect.

CONCLUSIONS

Interpretation of CIs is important but occurs infrequently in study reports of trials with treatment effects that are not statistically significant. Increased author interpretation of CIs could improve application of RCT results. Reporting recommendations are provided.

摘要

目的

在治疗效果无统计学显著性的随机临床试验(RCT)中,对置信区间(CI)进行解读,能够区分“阴性”结果(数据与具有临床意义的治疗效果不一致)和“不确定”结果(数据仍与具有临床意义的治疗效果的可能性一致)。这种解读对于确保在未来研究或临床实践中,不会基于无效结论而过早放弃潜在有益的治疗方法非常重要。

设计

对2014年发表在《》《》《》《》和《》上的RCT报告进行系统评价(n = 247)。

结果

99篇治疗效果无统计学显著性的文章中,有85篇报告了治疗效果的CI。这99篇文章中只有17篇对CI进行了解读。在22篇CI表明结果不确定的文章中,只有4篇承认该研究不能排除具有临床意义的治疗效果。

结论

对CI进行解读很重要,但在治疗效果无统计学显著性的试验研究报告中却很少出现。作者对CI解读的增加可以改善RCT结果的应用。本文提供了报告建议。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e1b/5726092/04e1cd69ccc6/bmjopen-2017-017288f01.jpg

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