The randomized clinical trial: bias in analysis.

The realization that bias in patient selection may influence the results of clinical studies has helped to establish the randomized controlled clinical trial in medical research. However, bias can be equally important at other stages of a trial, especially at the time of analysis. Withdrawing patients from consideration in the analysis because of ineligibility on account of study entry criteria, lack of compliance to the protocol, or data of poor quality may be a source of systematic error. Examples to illustrate the possible consequences are taken from trials in the cardiovascular field. We recommended that reported study results should include outcome data from all subjects randomized in the group to which they were originally assigned.

[1]  Sulfinpyrazone in the prevention of cardiac death after myocardial infarction. The Anturane Reinfarction Trial. , 1978, The New England journal of medicine.

[2]  D. Sackett,et al.  Controversy in counting and attributing events in clinical trials. , 1979, The New England journal of medicine.

[3]  Anna C. Balazs,et al.  Influence of adherence to treatment and response of cholesterol on mortality in the coronary drug project. , 1980, The New England journal of medicine.

[4]  Q E Whiting-O'Keefe,et al.  Controlled clinical trials. , 1983, The American journal of medicine.

[5]  Max Halperin,et al.  Sample sizes for medical trials with special reference to long-term therapy , 1968 .

[6]  K Uberla,et al.  Secondary Prevention of Myocardial Infarction Comparison of Acetylsalicylic Acid, Phenprocoumon and Placebo , 1979, Thrombosis and Haemostasis.

[7]  J. Ware,et al.  Randomized clinical trials. Perspectives on some recent ideas. , 1976, The New England journal of medicine.

[8]  P. Armitage,et al.  Design and analysis of randomized clinical trials requiring prolonged observation of each patient. I. Introduction and design. , 1976, British Journal of Cancer.

[9]  T C Chalmers,et al.  ETHICS IN COOPERATIVE CLINICAL TRIALS , 1970, Annals of the New York Academy of Sciences.

[10]  K. Uberla,et al.  Secondary prevention of myocardial infarction: a comparison of acetylsalicylic acid, placebo and phenprocoumon. , 1980, Haemostasis.

[11]  Proceedings of the Workshop on platelet-active drugs in the secondary prevention of cardiovascular events. February 20-21, 1980, National Institutes of Health, Bethesda, Maryland. , 1980, Circulation.

[12]  M. Schork,et al.  The determination of sample size in treatment-control comparisons for chronic disease studies in which drop-out or non-adherence is a problem. , 1967, Journal of chronic diseases.

[13]  G. Kolata FDA says no to anturane. , 1980, Science.

[14]  J. Hampton,et al.  Randomised trial comparing propranolol with atenolol in immediate treatment of suspected myocardial infarction. , 1980, British medical journal.

[15]  J. Wittes,et al.  Analysis of data from clinical trials. , 1983, Annals of internal medicine.

[16]  D. DeMets,et al.  Sample sizes for long-term medical trial with time-dependent dropout and event rates. , 1980, Controlled clinical trials.