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If you dont understand a measurement, you cant Nominal < Ordinal < Continuous
possibly determine statistical or clinical significance You can use a statistical test designed for a lower level
APACHE II Score? of measure of a dependent variable, but [in general]
SOFA Score?
not the other way around
Somewhat controversial
Child-Pugh Score?
Using parametric methods to analyze pain measurements, that
aPTT are generally ordinal variables [nonparametric]
Continuous variables are often surrogate outcomes
Thus,are lower levels of measurement clinically
The mathematical and clinical hierarchy of levels of
measurement do not match
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Measures of Variability
Range
Outer fence = 3 IQR
Standard deviation
Standard Error of the Mean (SEM)
}
Measure of precision for the mean estimate
Not a measure of variability Whisker = 1.5 IQR
Interquartile range (IQR)
IQR
25th-75th
Box Plots
percentile
25-75th
percentile
{
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Decision The Truth There cannot be Type I and Type II errors at the
same time, for the same dependent variable
Equal Different Type I error is only a possible problem when there is
statistical significance
Groups are Type II error is only a possible problem when there
Equal Correct Type II error
is no statistical significance
Smallstudies that find a difference have a sufficient
Groups are sample size
Different Type I error Correct These studies are NOT under-powered
A sample that is too small is under-powered A sample that is too large can result in over-
A sample that is too small may suggest an important powering
difference, but it would not be statistically significant Statistically
significant differences that are clinically
We could miss a potentially valuable intervention irrelevant
A sample that is too small may show no difference, but Wastes resources [time and money] and put patients at
we dont know if there is really no difference or just did unnecessary risk
not have the power to detect a difference
Too small a sample wastes resources [time and money]
and may put patients at unnecessary risk
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240/400 = 60% 144/400 = 36% 24% 17% to 31%* Braitman LE. Ann Intern Med 1991;114:515-7.
Risk in unexposed = Absolute Risk Drug No Drug RR Increased risk Absolute increase
500/1000 300/1000 1.67 67% 200 more per 1000
100/1000 60/1000 1.67 67% 40 more per 1000
Absolute Risk (exposed) = Relative Risk (RR) 5/1000 3/1000 1.67 67% 2 more per 1000
Absolute Risk (unexposed)
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GUSTO GUSTO
Hemorrhagic Stroke
Relative Risk 0.86 104/20,023 = 0.52% for streptokinase
Relative Risk Reduction 13.6% * 0.72% for t-PA
(CI) (5.9% to 21.3%) Attributable risk = 0.72% - 0.52% = 0.2%
Absolute Risk Reduction 1% NNH = 1 AR = 1 0.002 = 500
(CI) (0.4% to 1.7%)
NNT 100 (250 to 59)
*Based on CI given in article, not calculated 14%
Estimated based on CI of RRR
The Gusto Investigators. NEJM 1993;329:673. The Gusto Investigators. NEJM 1993;329:673.
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Chi-square Chi-square
Determine whether the data meet the assumptions Assumptions
of the test Independent observations
For a 2x2 table, consider using the Yates correction Expected cell frequencies (ECF) = RT * CT/GT
Most common No ECF < 1
Considered conservative No more than 20% has an ECF <5
More difficult to find a 1 cell < 5 in a 2x2 table
statistically significant difference
If not met
Type II error
Descriptive stats
Collapse categories
Fishers Exact Test
Chi-square Chi-square
No Row No Row
Bleeding Bleeding Totals Bleeding Bleeding Totals
Individualized 1 49 50 Individualized 1 49 50
Enoxaparin Enoxaparin
(4.9) (45.1) (4.9) (45.1)
Conventional 9 44 53 Conventional 9 44 53
Enoxaparin Enoxaparin
(5.1) (47.9) (5.1) (47.9)
Column 10 93 103 Column 10 93 103
Totals Totals
Chi-Square p = 0.03 Fishers Exact p = 0.02
Barras MA. Clin Pharmacol Ther 2008;83:882-8. Barras MA. Clin Pharmacol Ther 2008;83:882-8.
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Chi-square Chi-square
No No
Relapsing Relapsing Row Relapsing Relapsing Row
Spasm Spasm Totals Spasm Spasm Totals
Vigabatrin 0 16 16 Vigabatrin 0 16 16
(2) (14) (2) (14)
ACTH 4 12 16 ACTH 4 12 16
(2) (14) (2) (14)
Column 4 28 32 Column 4 28 32
Totals Totals
Chi Square p = 0.03 Fishers Exact = 0.10
Cossette P. Neurology 1999;52:1691-4.
Cossette P. Neurology 2000;54:539. [Erratum]
Two
data
groups and two outcomes [only]
Exposure Outcome
More than 2x2? (DRUG)
Split into several 2x2 tables
Increases Type I error Other explanatory
Freeman-Halton extension variables that could
affect outcome
Useful when a nominal
outcome is rare
Or for small samples
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Clinical progression
Cumulative Survival
Kaplan-Meier Plot
Log-Rank Test
Cox Proportional Hazard Model
Hazard Ratio (HR)
0
Time
Questions?
rhatton@cop.ufl.edu
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