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死于p值:重症监护研究中对p值的过度依赖。

Death by p-value: the overreliance on p-values in critical care research.

作者信息

Patel Sharad, Green Adam

机构信息

Department of Critical Care Medicine, Cooper University Health Care and Cooper Medical School of Rowan University, 1 Cooper Plaza, Camden, NJ, 08103, USA.

出版信息

Crit Care. 2025 Feb 11;29(1):73. doi: 10.1186/s13054-025-05307-9.

Abstract

The p-value has changed from a versatile tool for scientific reasoning to a strict judge of medical information, with the usual 0.05 cutoff frequently deciding a study's significance and subsequent clinical use. Through an examination of five critical care interventions that demonstrated meaningful treatment effects yet narrowly missed conventional statistical significance, this paper illustrates how rigid adherence to p-value thresholds may obscure therapeutically beneficial findings. By providing a clear, step-by-step illustration of a basic Bayesian calculation, we demonstrate that clinical importance can remain undetected when relying solely on p-values. These observations challenge current statistical paradigms and advocate for hybrid approaches-including both frequentist and Bayesian methodologies-to provide a more comprehensive understanding of clinical data, ultimately leading to better-informed medical decisions.

摘要

P值已从科学推理的通用工具转变为医学信息的严格评判标准,通常以0.05作为临界值,常常据此判定一项研究的意义及后续临床应用。通过对五项重症监护干预措施的考察,这些措施显示出有意义的治疗效果,但勉强未达到传统统计学显著性水平,本文阐明了严格遵循P值阈值可能会掩盖具有治疗益处的发现。通过清晰、逐步地展示基本贝叶斯计算方法,我们证明,仅依靠P值时,临床重要性可能会被忽视。这些观察结果对当前的统计范式提出了挑战,并倡导采用混合方法——包括频率学派和贝叶斯方法——以更全面地理解临床数据,最终做出更明智的医疗决策。

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本文引用的文献

1
Redefine statistical significance.重新定义统计学显著性。
Nat Hum Behav. 2018 Jan;2(1):6-10. doi: 10.1038/s41562-017-0189-z.
2
Scientists rise up against statistical significance.科学家们奋起反对统计显著性。
Nature. 2019 Mar;567(7748):305-307. doi: 10.1038/d41586-019-00857-9.
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Adaptive Designs for Clinical Trials.临床试验的适应性设计
N Engl J Med. 2016 Jul 7;375(1):65-74. doi: 10.1056/NEJMra1510061.
6
Trial of Continuous or Interrupted Chest Compressions during CPR.心肺复苏期间持续或间断胸外按压的试验。
N Engl J Med. 2015 Dec 3;373(23):2203-14. doi: 10.1056/NEJMoa1509139. Epub 2015 Nov 9.
9
Outcomes and statistical power in adult critical care randomized trials.成人重症监护随机试验的结果和统计效能。
Am J Respir Crit Care Med. 2014 Jun 15;189(12):1469-78. doi: 10.1164/rccm.201401-0056CP.

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