• Edward J Mascha and Thomas R Vetter.
• From the Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, Ohio.
• Anesth. Analg. 2018 Feb 1; 126 (2): 691-698.

AbstractInferential statistics relies heavily on the central limit theorem and the related law of large numbers. According to the central limit theorem, regardless of the distribution of the source population, a sample estimate of that population will have a normal distribution, but only if the sample is large enough. The related law of large numbers holds that the central limit theorem is valid as random samples become large enough, usually defined as an n ≥ 30. In research-related hypothesis testing, the term "statistically significant" is used to describe when an observed difference or association has met a certain threshold. This significance threshold or cut-point is denoted as alpha (α) and is typically set at .05. When the observed P value is less than α, one rejects the null hypothesis (Ho) and accepts the alternative. Clinical significance is even more important than statistical significance, so treatment effect estimates and confidence intervals should be regularly reported. A type I error occurs when the Ho of no difference or no association is rejected, when in fact the Ho is true. A type II error occurs when the Ho is not rejected, when in fact there is a true population effect. Power is the probability of detecting a true difference, effect, or association if it truly exists. Sample size justification and power analysis are key elements of a study design. Ethical concerns arise when studies are poorly planned or underpowered. When calculating sample size for comparing groups, 4 quantities are needed: α, type II error, the difference or effect of interest, and the estimated variability of the outcome variable. Sample size increases for increasing variability and power, and for decreasing α and decreasing difference to detect. Sample size for a given relative reduction in proportions depends heavily on the proportion in the control group itself, and increases as the proportion decreases. Sample size for single-group studies estimating an unknown parameter is based on the desired precision of the estimate. Interim analyses assessing for efficacy and/or futility are great tools to save time and money, as well as allow science to progress faster, but are only 1 component considered when a decision to stop or continue a trial is made.

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