CLINICALLY USEFUL MEASURES OF EFFECT IN BINARY ANALYSES OF RANDOMIZED TRIALS
CLINICALLY USEFUL MEASURES OF EFFECT IN BINARY ANALYSES OF RANDOMIZED TRIALS
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DOI：
10.1016/0895-4356(94)90191-0
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发表时间：
1994-08-01
影响因子：
7.2
通讯作者：
BRACKEN, MB
中科院分区：
文献类型：
--
作者：
SINCLAIR, JC;BRACKEN, MB
随机临床试验的结果可以使用治疗效果的相对和/或绝对估计值报告。这些不同的测量传达不同的信息，并且选择可以影响医生对治疗效果的大小的评价，以及随后的治疗决定。我们比较的估计与临床相关的信息传达给医生，并确定哪些临床问题可以和不能直接回答每个。我们还确定了当一个估计量被另一个估计量替代时，或者当一个估计量被错误标记时，误解的机会。临床上重要的问题是最直接的解决报告相对和绝对的影响，使用相对风险及其补充，相对风险降低，风险差异及其倒数，需要治疗的数量。这是真实的治疗效果的估计来自一个单一的试验，也从一组试验的荟萃分析。因为对照组的风险影响比值比的数值，所以在向医生传达临床重要信息时，比值比不能代替风险比。当在高基线风险人群中进行的试验显示出较大的治疗效果时，这一点尤其重要。
The results of a randomized clinical trial can be reported using relative and/or absolute estimators of treatment effect. These various measures convey different information, and the choice can influence the physician's appreciation of the size of treatment effect and, subsequently, treatment decisions. We compare the estimators with respect to the clinically relevant information conveyed to physicians, and identify which clinical questions can and cannot be answered directly by each. We also identify opportunities for misinterpretation when one estimator is substituted for another, or when an estimator is mislabeled. Clinically important questions are addressed most directly by reporting both relative and absolute effects using relative risk and its complement, relative risk reduction, and risk difference and its reciprocal, number needed to treat. This is true of estimates of treatment effect derived from a single trial and also from meta-analysis of a group of trials. Because the control group's risk affects the numerical value of the odds ratio, the odds ratio cannot substitute for the risk ratio in conveying clinically important information to physicians. This is especially important when large treatment effects are shown in trials carried out in populations at high baseline risk.