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An association between ICP-derived data and outcome in TBI patients: The role of sample size

Accepted version
Peer-reviewed

Type

Article

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Authors

Cabella, Brenno 
Liu, Xiuyun 
Cabeleira, Manuel 

Abstract

Background: Many demographic and physiological variables have been associated with outcome after TBI. However, with small sample sizes, making spurious inferences is possible. This paper explores the effect of sample sizes on statistical relationships between patient variables (both physiological and demographic) and outcome.

Methods: Data from head-injured patients with monitored arterial blood pressure, intracranial pressure (ICP) and outcome assessed at 6 months were included in this retrospective analysis. A univariate logistic regression analysis was performed to obtain the odds ratio (OR) for unfavourable outcome. Three different dichotomizations between favourable and unfavourable outcomes were considered. A bootstrap method was implemented to estimate the minimum sample sizes needed to obtain reliable association between physiological and demographic variables with outcome.

Results: In a univariate analysis with dichotomized outcome, samples sizes should be generally larger than 100 for reproducible results. Pressure reactivity index, ICP and ICP slow waves offered the strongest relationship with outcome. Relatively small sample sizes may overestimate effect sizes or even produce conflicting results.

Conclusion: Low power tests, generally achieved with small sample sizes, may produce misleading conclusions, especially when they are based only on p-values and the dichotomized criteria of rejecting/not-rejecting the null hypothesis. We recommend reporting confidence intervals and effect sizes in a more complete and contextualized data analysis.

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Keywords

Journal Title

Neurocritical Care

Conference Name

Journal ISSN

1541-6933
1556-0961

Volume Title

Publisher

Springer

Publisher DOI

Publisher URL

Sponsorship
MRC (G0600986)
MRC (G0601025)
NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC) (HTA/12/35/57)
TCC (NIHR-RP-R3-12-013)
National Institute of Health Research (Cambridge Centre) and NIHR Health Technology Co-operative, CNPQ Scholarship (Research Project 203792/2014-9), Woolf Fisher Trust Scholarship, Cambridge Commonwealth European and International Trust Scholarship, Gates Cambridge Trust Scholarship