Clinical Trials

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❘❙❚■ Chapter 36 | Use of FiguresFunnel plotsA funnel plot can also be used to compare the treatment effects of individualstudies in a meta-analysis. It is essentially a plot of the study precision againstthe corresponding treatment effect (see Chapter 38 for more). Funnel plots aregood for examining publication bias [7], but are not fully robust. In a reviewof 198 published meta-analyses, the shape of the funnel was determined by anarbitrary choice of the method to construct the plot. When different definitions ofprecision and/or effect measure were used, the conclusion about the shape of thefunnel changed in 86% of cases [8].Graphs for three variablesOther, less common, graphs that are used to display three dimensions includemosaic displays, icons, and surface plots. In brief, a mosaic display uses thestrengths of a bar chart to represent multiway contingency tables [9]. Icons area potential supplement to bar charts or pie charts, particularly when the samplesize is small [10]. Surface plots are useful for displaying quantitative data in threedimensions, ie, there are x, y, and z axes for plotting points and the graph must beprinted in a three dimensional representation [11].ConclusionGraphical representation facilitates the evaluation and comparison of outcomevariables among different groups, and enables an appropriate choice of statisticalmethods. In this chapter, we have explored a variety of graphs that are commonlyused in clinical reports (see Table 2 for a summary). The choice of graph isdetermined by the purpose of the exercise and the type of data to present. In atrial report, all of the graphs should be appropriately labeled and containsufficient information without needing to refer back to the text. Sometimes morethan one graph is required, giving importance to simplicity.References1. Petrie A, Sabin C. Medical Statistics at a Glance. Oxford: Blackwell Publishing, 2000.2. Kirkwood BR, Sterne JAC. Essential Medical Statistics. Oxford: Blackwell Publishing, 2003.3. Norleans MX. Statistical Methods for Clinical Trials. New York: Marcel Dekker, 2000.4. Dragsted UB, Gerstoft J, Pedersen C, et al. Randomized trial to evaluate indinavir/ritonavirversus saquinavir/ritonavir in human immunodeficiency virus type 1-infected patients:the MaxCmin 1trial. J Infect Dis 2003;188:635–42.5. Alderson P, Roberts I. Corticosteroids in acute traumatic brain injury: systematic reviewof randomised controlled trials. BMJ 1997;314:1855–9.424
Clinical Trials: A Practical Guide ■❚❙❘6. Bailey KR. Inter-study differences: how should they influence the interpretation and analysisof results? Stat Med 1987;6:351–60.7. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple,graphical test. BMJ 1997;315:629–34.8. Tang JL, Liu JL. Misleading funnel plot for detection of bias in meta-analysis. J Clin Epidemiol2000;53:477–84.9. Friendly M. Mosaic displays for multi-way contingency tables. J Am Stat Assoc 1994;89:190–200.10. Elting LS, Martin CG, Cantor SB, et al. Influence of data display formats on physicianinvestigators’ decision to stop clinical trials: prospective trial with repeated measures.BMJ 1999;318:1527–31.11. Phillips M, Cataneo RN, Greenberg J, et al. Breath markers of oxidative stress in patientswith unstable angina. Heart Dis 2003;5:95–9.425
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❘❙❚■ ContributorsStephen L
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Clinical Trials: A Practical Guide
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■■❚❙❘Chapter 1RandomizedC
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❘❙❚■ Chapter 2 | Uncontroll
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■■❚❙❘Chapter 3Protocol De
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■■❚❙❘Chapter 4EndpointsAm
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■■❚❙❘Chapter 6Source and
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■■❚❙❘Part IIAlternativeTr
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❘❙❚■ Chapter 10 | Crossover
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■■❚❙❘Part IIIBasics ofSta
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■■❚❙❘Chapter 17Types of D
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■■❚❙❘Chapter 19Comparison
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■■❚❙❘Chapter 20Comparison
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■■❚❙❘Part IVSpecial Trial
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■■❚❙❘Chapter 22Intention-
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■■❚❙❘Chapter 23Subgroup A
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■■❚❙❘Chapter 24Regression
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■■❚❙❘Chapter 29Multiplici
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■■❚❙❘Chapter 31Interim Mo
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■■❚❙❘Chapter 32Overview o
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