Formula-Free Statistics
Learning objectives
Variability
Patients vary.
Physicians vary.
Nurses vary.
Hospitals vary.
Measurements vary.
Disease states vary.
Immune response varies.
Drug adherence varies.
Variability
Consequences of variability
Uncertaintyisanuncomfortableposition.
Butcertaintyisanabsurdone.
Voltaire
What is Statistics?
Random sample
Population
Calculation
Calculation
Population mean
blood pressure
Inference
Inference
Sample mean
blood pressure
Hig
h
BP
Random sample
Population
Low
BP
Calculation
Calculation
Population difference
between groups in
mean blood pressure
Inference
Inference
Sample difference
between groups in
mean blood pressure
statistically significant
More on this later
mean
Red flag
Comparisons
Hypothesis testing
An example:
BedsideLimitedEchocardiographybytheEmergencyPhysicianIsAccurate
DuringEvaluationoftheCriticallyIllPatient
Pershadetal.Pediatrics2004;114;e667e671.
Hypothesis testing
Patient Emerg Doc Cardiographer
Shortening fraction
SF (%)
Hypothesis testing
Difference between
measurements made by
echocardiographers and
emergency physicians
Hypothesis testing
Difference between
measurements made by
echocardiographers and
emergency physicians
On average
echocardiographers
estimates were
higher by 4.4%.
Hypothesis testing
Difference between
measurements made by
echocardiographers and
emergency physicians
On average
echocardiographers
estimates were
higher by 4.4%.
Could this
difference be a
chance occurrence?
Hypothesis testing
Hypothesis testing
Difference between
measurements made by
echocardiographers and
emergency physicians
On average
echocardiographers
estimates were
higher by 4.4%.
P=0.003 (t-test)
statistically
significant
Red flag
Confidence intervals
Hypothesis testing
Difference between
measurements made by
echocardiographers and
emergency physicians
On average
echocardiographers
estimates were
higher by 4.4%.
The 95% confidence
interval is
1.6% 7.2%.
Statisticsmeansneverhavingtosay
yourecertain.
Hypothesis testing
Patient Emerg Doc Cardiographer
Inferior vena
cava (IVC)
diameter(mm)
Hypothesis testing
Difference between
measurements made by
echocardiographers and
emergency physicians
Hypothesis testing
Difference between
measurements made by
echocardiographers and
emergency physicians
On average
echocardiographers
estimates were
higher by 0.068 mm
P=0.14
Not statistically
significant
Hypothesis testing
Hypothesis testing
Hypothesis testing
Difference between
measurements made by
echocardiographers and
emergency physicians
On average
echocardiographers
estimates were higher
by 0.068 mm
The 95% confidence
interval is -0.025 to
0.16 mm.
Red flag
Association
Group Group
A
B
50%
5%
25%
30%
3%
5%
Absolute risk
reduction
Relative
risk
Odds
ratio
20%
0.6
0.43
(NNT=5)
(RRR=40%)
2%
0.6
(NNT=50)
(RRR=40%)
20%
0.2
(NNT=5)
(RRR=80%)
0.59
0.16
Compare with:
Patients who received the new surgical technique
recovered quicker.
Correlationdoesnotimplycausation.
Red flag
Causal inferences in an
observational study
Anobservationalstudycandetectan
association,butnot(byitself)causation.
Adjusted analyses
linear regression
logistic regression
Poisson regression
Cox proportional hazards regression
Cochran-Mantel-Haenszel methods
Biases
Study designs
Power and sample size determination
Other statistical methods
Summary
VarietyVariabilityisthespiceoflife.