Journal article
The statistical stability of clavicle fracture management: A systematic review of randomized controlled trials with fragility analysis
Journal of back and musculoskeletal rehabilitation, v 38(1), pp 63-70
01 Jan 2025
PMID: 39970459
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background Randomized controlled trials (RCTs) represent the highest level of evidence in guiding the management of clavicle fractures. They are conducted to ensure that evidence drives the basis of treatment algorithms. Relying solely on P values to assess orthopedic RCTs may be deceptive and challenge the validity of the studies.Objective To evaluate the degree of statistical fragility in the clavicle fracture literature using the fragility index (FI) and fragility quotient (FQ).Methods A systematic search strategy using the Medline, PubMed, and Embase databases was used to find all dichotomous data for randomized controlled trials (RCTs) in clavicle fracture research from 2000 to 2024. The FI of each outcome was calculated by reversing a single outcome event until significance was reversed. The FQ was calculated by dividing each fragility index by the study sample size. The interquartile range (IQR) was also calculated for the FI and FQ.Results Of the 3646 articles screened, 81 met the search criteria, with 30 RCTs evaluating clavicle fractures included for analysis. There were 250 total outcomes, where 62 significant and 188 nonsignificant outcomes were identified. The overall FI and FQ were 4 (IQR 3-5) and 0.045 (IQR 0.024-0.080). Statistically significant and nonsignificant outcomes had an FI of 3.5 (IQR 2-7) and 4 (IQR 3-5), respectively. Regarding loss to follow-up (LTF), 63.3% (19) reported LTF greater or equal to the overall FI of 4.Conclusion When scrutinizing management algorithms relying on statistical analysis, we recommend including the FI and FQ alongside the P value.
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Details
- Title
- The statistical stability of clavicle fracture management: A systematic review of randomized controlled trials with fragility analysis
- Creators
- Michael N. Megafu - University of ConnecticutElisabeth Point Du Jour - Geisinger Commonwealth School of MedicineJanet Nguyen - Geisinger Commonwealth School of MedicineEmmanuel Megafu - Geisinger Commonwealth School of MedicineHassan Mian - University of MinnesotaSulabh Singhal - Drexel UniversityPaul Tornetta III - Boston UniversityRobert L. Parisien - Mount Sinai Health System
- Publication Details
- Journal of back and musculoskeletal rehabilitation, v 38(1), pp 63-70
- Publisher
- Sage
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:001482274200001
- Scopus ID
- 2-s2.0-85219085219
- Other Identifier
- 991022197436504721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Orthopedics
- Rehabilitation