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One Patient, Two Patient, Three Patient, Four - When Patients Are Counted, but Not Accounted For: Pseudoreplication in Medicine

  • Francis A.M. Manno
  • , Sinai H.C. Manno
  • , Irfan Ahmed
  • , Yuanchao Liu
  • , Shuk Han Cheng
  • , Condon Lau

Research output: Chapter in Book/Report/Conference proceeding › Conference contribution › peer-review

2 Citations (Scopus)

Abstract

Background: Pseudoreplication is a statistical error occurring when treatments are not replicated or replicates are not statistically independent. Description and explanation of pseudoreplication is absent from medical literature. There are four types of pseudoreplication: simple, temporal, implicit, and pooling. Methods: The present article reviews the occurrence of type I errors caused by pseudoreplication in prominent medical journals. Fifty articles, ten randomly chosen from five prominent journals: JAMA, BMJ, The New England Journal of Medicine, The Lancet, and The Annals of Internal Medicine, were analyzed for the occurrence of pseudoreplication, and in particular which statistical comparison was utilized most resulting in this error. The unit of analysis was the article for group assessments and the statistical test within each article for comparisons. Multivariate analyses were carried out to determine the correlation of pseudoreplication type with parameters in the manuscript. Results: A total of 1,294 statistical comparisons of different hypotheses were assessed, averaging 25.9 (SE=4.2) per article. Pseudoreplication occurred an average of 37.38% (SE=5.0) per statistic utilized in studies. Temporal pseudoreplication occurred most frequently. Temporal and implicit pseudoreplication were significantly related to the first statistic (F=3.45, df=6,43, P<0.007 and F=5.32, df=6,43, P<0.0004, respectively) and simple pseudoreplication was significantly related to the second statistic utilized, F=2.81, df=5,44, P<0.03. The number of M.D.'s on a study was significantly related to pseudoreplication as determined by Roy's Largest Root = 1.2, F=2.18, df=13,23, P<0.05. Conclusions: Pseudoreplication is a serious statistical problem related to the improper implementation and analysis of statistics. Physicians and medical scientists need to be cognizant of the manner in which the error occurs to prevent Type I error.

Original languageEnglish
Title of host publicationProceedings - 9th International Conference on Information Technology in Medicine and Education, ITME 2018
Pages260-264
Number of pages5
ISBN (Electronic)9781538677438
DOIs
Publication statusPublished - 26 Dec 2018
Externally publishedYes
Event9th International Conference on Information Technology in Medicine and Education, ITME 2018 - Hangzhou, Zhejiang, China
Duration: 19 Oct 2018 → 21 Oct 2018

Publication series

NameProceedings - 9th International Conference on Information Technology in Medicine and Education, ITME 2018

Conference

Conference9th International Conference on Information Technology in Medicine and Education, ITME 2018
Country/TerritoryChina
CityHangzhou, Zhejiang
Period19/10/18 → 21/10/18

Keywords

  • Assumptions
  • Errors
  • Pseudoreplication
  • Replicates
  • Samples
  • Unit of Analysis

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