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Minh-Son To and Alistair Jukes

OBJECTIVE

The objective of this study was to evaluate the trends in reporting of p values in the neurosurgical literature from 1990 through 2017.

METHODS

All abstracts from the Journal of Neurology, Neurosurgery, and Psychiatry (JNNP), Journal of Neurosurgery (JNS) collection (including Journal of Neurosurgery: Spine and Journal of Neurosurgery: Pediatrics), Neurosurgery (NS), and Journal of Neurotrauma (JNT) available on PubMed from 1990 through 2017 were retrieved. Automated text mining was performed to extract p values from relevant abstracts. Extracted p values were analyzed for temporal trends and characteristics.

RESULTS

The search yielded 47,889 relevant abstracts. A total of 34,324 p values were detected in 11,171 abstracts. Since 1990 there has been a steady, proportionate increase in the number of abstracts containing p values. There were average absolute year-on-year increases of 1.2% (95% CI 1.1%–1.3%; p < 0.001), 0.93% (95% CI 0.75%–1.1%; p < 0.001), 0.70% (95% CI 0.57%–0.83%; p < 0.001), and 0.35% (95% CI 0.095%–0.60%; p = 0.0091) of abstracts reporting p values in JNNP, JNS, NS, and JNT, respectively. There have also been average year-on-year increases of 0.045 (95% CI 0.031–0.059; p < 0.001), 0.052 (95% CI 0.037–0.066; p < 0.001), 0.042 (95% CI 0.030–0.054; p < 0.001), and 0.041 (95% CI 0.026–0.056; p < 0.001) p values reported per abstract for these respective journals. The distribution of p values showed a positive skew and strong clustering of values at rounded decimals (i.e., 0.01, 0.02, etc.). Between 83.2% and 89.8% of all reported p values were at or below the “significance” threshold of 0.05 (i.e., p ≤ 0.05).

CONCLUSIONS

Trends in reporting of p values and the distribution of p values suggest publication bias remains in the neurosurgical literature.

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Michael Glantz and Nicholas Brandmeir

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Bradley R. Crammond, MBiostat, Neela Janakiramanan, Mario Ganau, Deborah Verran, Laura Lippa, Jonathan Braman, and Katrin Rabiei

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Bradley R. Crammond, MBiostat, Neela Janakiramanan, Mario Ganau, Deborah Verran, Laura Lippa, Jonathan Braman, and Katrin Rabiei

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Franz E. Babl, Mark D. Lyttle, Natalie Phillips, Amit Kochar, Sarah Dalton, John A. Cheek, Jeremy Furyk, Jocelyn Neutze, Silvia Bressan, Amanda Williams, Stephen J. C. Hearps, MBiostat, Ed Oakley, Gavin A. Davis, Stuart R. Dalziel, and Meredith L. Borland

OBJECTIVE

Current clinical decision rules (CDRs) guiding the use of CT scanning in pediatric traumatic brain injury (TBI) assessment generally exclude children with ventricular shunts (VSs). There is limited evidence as to the risk of abnormalities found on CT scans or clinically important TBI (ciTBI) in this population. The authors sought to determine the frequency of these outcomes and the presence of CDR predictor variables in children with VSs.

METHODS

The authors undertook a planned secondary analysis on children with VSs included in a prospective external validation of 3 CDRs for TBI in children presenting to 10 emergency departments in Australia and New Zealand. They analyzed differences in presenting features, management and acute outcomes (TBI on CT and ciTBI) between groups with and without VSs, and assessed the presence of CDR predictors in children with a VS.

RESULTS

A total of 35 of 20,137 children (0.2%) with TBI had a VS; only 2 had a Glasgow Coma Scale score < 15. Overall, 49% of patients with a VS underwent CT scanning compared with 10% of those without a VS. One patient had a finding of TBI on CT scanning, with positive predictor variables on CDRs. This patient had a ciTBI. No patient required neurosurgery. For children with and without a VS, the frequency of ciTBI was 2.9% (95% CI 0.1%–14.9%) compared with 1.4% (95% CI 1.2%–1.6%) (difference 1.5% [95% CI −4.0% to 7.0%]), and TBI on CT 2.9% (95% CI 0.1%–14.9%) compared with 2.0% (95% CI 1.8%–2.2%) (difference 0.9%, 95% CI −4.6% to 6.4%).

CONCLUSIONS

The authors’ data provide further support that the risk of TBI is similar for children with and without a VS.