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Reviews on Recent Clinical Trials

Editor-in-Chief

ISSN (Print): 1574-8871
ISSN (Online): 1876-1038

Short Communication

Confidence Interval: Advantages, Disadvantages and the Dilemma of Interpretation

Author(s): Pramod K. Sharma* and Mamta Yadav

Volume 19, Issue 1, 2024

Published on: 01 December, 2023

Page: [76 - 80] Pages: 5

DOI: 10.2174/0115748871266250231120043345

Price: $65

Abstract

Confidence interval (CI) is one of the important reporting tools for research data as it not only provides valuable information about the effect size along with its width but also possible clinical significance. Unfortunately, this approach is not being utilized to its fullest extent. Determining point estimate always includes an element of uncertainty due to associated sampling error. A confidence interval may be an appropriate tool to measure this uncertainty. Further, the P value does not convey information about the magnitude of an effect and the error associated with it. Thus, in an ideal situation effect size should preferably be associated with a confidence interval to assess precision. Not only does CI let us assess likely effects but also decides whether the intervention applied could have clinical utility. In contrast, the p-value limits our option to either reject any differences that are not significant or accept those that are. However, confidence intervals are commonly misinterpreted. It is imperative to understand that the CI is not the range of effects that 95% of patients in the population exhibit. Moreover, it would also be erroneous to say that there is a 95% probability that the CI includes the true population effect. Interpretation is usually based on the context in which the confidence interval is being looked at. From a utility point of view and like other statistical tools confidence interval approach does have several advantages as well as disadvantages and is far beyond being a perfect statistical tool.

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[1]
Chandra A, Khullar D, Lee TH. Addressing the challenge] of gray-zone medicine. N Engl J Med 2015; 372(3): 203-5.
[http://dx.doi.org/10.1056/NEJMp1409696] [PMID: 25587945]
[2]
Barry AE, Reyes J, Szucs L, Goodson P, Valdez D. Should we be confident in published research? a case study of confidence interval reporting in health education and behavior research. Health Behaviour Research 2021; 4(1): 1-11.
[3]
Freire APCF, Elkins MR, Ramos EMC, Moseley AM. Use of 95% confidence intervals in the reporting of between-group differences in randomized controlled trials: Analysis of a representative sample of 200 physical therapy trials. Braz J Phys Ther 2019; 23(4): 302-10.
[http://dx.doi.org/10.1016/j.bjpt.2018.10.004] [PMID: 30366845]
[4]
Bevans R. Understanding Confidence Intervals-Easy Examples & Formulas 2022. Available from: https://www.scribbr.com/statistics/confidence-interval/ (Accessed on: Nov 18, 2022).
[5]
Greenland S, Senn SJ, Rothman KJ, et al. Statistical tests, P values, confidence intervals, and power: A guide to misinterpretations. Eur J Epidemiol 2016; 31(4): 337-50.
[http://dx.doi.org/10.1007/s10654-016-0149-3] [PMID: 27209009]
[6]
Rothman J. A show of confidence. N Engl J Med 1978; 299(24): 1362-3.
[http://dx.doi.org/10.1056/NEJM197812142992410] [PMID: 362205]
[7]
Naimi AI, Whitcomb BW. Can confidence Intervals be interpreted? Am J Epidemiol 2020; 189(7): 631-3.
[http://dx.doi.org/10.1093/aje/kwaa004] [PMID: 31994696]
[8]
Wasserstein RL, Lazar NA. The ASA statement on p-Values: Context, process, and purpose. Am Stat 2016; 70(2): 129-33.
[http://dx.doi.org/10.1080/00031305.2016.1154108]
[9]
Hazra A. Using the confidence interval confidently. J Thorac Dis 2017; 9(10): 4124-9.
[http://dx.doi.org/10.21037/jtd.2017.09.14] [PMID: 29268424]
[10]
Clay R. Confidence intervals for effect sizes from noncentral distributions. Open Science Collaboration 2014. Available from: http:// osc.centerforopenscience.org /2014/03/06/con1dence
[11]
Cumming G, Fidler F, Kalinowski P, Lai J. The] statistical recommendations of the American Psychological Association Publication Manual: Effect sizes, confidence intervals, and meta‐analysis. Aust J Psychol 2012; 64(3): 138-46.
[http://dx.doi.org/10.1111/j.1742-9536.2011.00037.x]
[12]
Thompson B. What future quantitative social science research could look like: Confidence intervals for effect sizes. Educ Res 2002; 31(3): 25-32.
[http://dx.doi.org/10.3102/0013189X031003025]
[13]
Goulet-Pelletier JC, Cousineau D. A review of effect sizes and their confidence intervals, Part I: The Cohen’s d family. Quant Methods Psychol 2018; 14(4): 242-65.
[http://dx.doi.org/10.20982/tqmp.14.4.p242]
[14]
Sandercock PAG. Short history of confidence intervals. Stroke 2015; 46(8): e184-7.
[http://dx.doi.org/10.1161/STROKEAHA.115.007750] [PMID: 26106115]
[15]
Clarke J. What is a CI? Evid Based Nurs 2012; 15(3): 66.
[http://dx.doi.org/10.1136/ebnurs-2012-100802] [PMID: 22767694]
[16]
Gardner MJ, Altman DG. Confidence intervals rather than P values: Estimation rather than hypothesis testing. BMJ 1986; 292(6522): 746-50.
[http://dx.doi.org/10.1136/bmj.292.6522.746] [PMID: 3082422]
[17]
Kamper SJ. Interpreting outcomes 2—Statistical significance and clinical meaningfulness: Linking evidence to practice. J Orthop Sports Phys Ther 2019; 49(7): 559-60.
[http://dx.doi.org/10.2519/jospt.2019.0704] [PMID: 31258048]
[18]
Kamper SJ. Confidence intervals: Linking evidence to practice. J Orthop Sports Phys Ther 2019; 49(10): 763-4.
[http://dx.doi.org/10.2519/jospt.2019.0706] [PMID: 31570078]
[19]
Schober P, Vetter TR. Confidence intervals in clinical research. Anesth Analg 2020; 130(5): 1303.
[http://dx.doi.org/10.1213/ANE.0000000000004731] [PMID: 32287136]
[20]
Schober P, Bossers SM, Schwarte LA. Statistical significance versus clinical importance of observed effect sizes: What do P values and confidence intervals really represent? Anesth Analg 2018; 126(3): 1068-72.
[http://dx.doi.org/10.1213/ANE.0000000000002798] [PMID: 29337724]
[21]
Vetter TR, Schober P. Regression: The apple does not fall far from the tree. Anesth Analg 2018; 127(1): 277-83.
[http://dx.doi.org/10.1213/ANE.0000000000003424] [PMID: 29771712]
[22]
Vetter TR, Schober P. Agreement analysis: What he said, she said versus you said. Anesth Analg 2018; 126(6): 2123-8.
[http://dx.doi.org/10.1213/ANE.0000000000002924] [PMID: 29677066]
[23]
Vetter TR, Schober P, Mascha EJ. Diagnostic testing and decision-making: Beauty is not just in the eye of the beholder. Anesth Analg 2018; 127(4): 1085-91.
[http://dx.doi.org/10.1213/ANE.0000000000003698] [PMID: 30096083]
[24]
Dodd WS, Jabbour PM, Sweid A, et al. Aneurysmal subarachnoid hemorrhage in patients with Coronavirus Disease 2019 (COVID-19): A case series. World Neurosurg 2021; 153: e259-64.
[http://dx.doi.org/10.1016/j.wneu.2021.06.092] [PMID: 34242830]
[25]
Kanat A, Aydin Y. Prognostic value and determinants of ultraearly angiographic vasospasm after aneurysmal subarachnoid hemorrhage. Neurosurgery 2000; 46(2): 505-7.
[http://dx.doi.org/10.1097/00006123-200002000-00053] [PMID: 10690744]

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