Abstract
The use of high-dose methylprednisolone for acute spinal cord injury continues to be a topic of debate. This controversy largely stems from fundamental issues in statistical interpretation of trial data, most notably subgroup analyses. The purpose of this review is to discuss important examples of improper subgroup analysis and encourage better practices in future research.
Highlights
The National Acute Spinal Cord Injury Studies (NASCIS) of the 1980s and 1990s promoted the use of high-dose methylprednisolone in acute spinal cord injury but were widely criticized in subsequent years on aspects of methodology and statistical analysis [1,2,3,4]
A 1978 study published in the New England Journal of Medicine used subgroup analysis to suggest that women with recent transient ischemic attacks (TIA) would not benefit from aspirin for stroke prevention [7]
The fundamental subgroup problems in the NASCIS trials are easy to overlook on a preliminary read
Summary
Reviewed by: Benjamin Aaron Emanuel, University of Southern California, United States Minjee Kim, Northwestern University, United States. Specialty section: This article was submitted to Neurocritical and Neurohospitalist Care, a section of the journal Frontiers in Neurology. The use of high-dose methylprednisolone for acute spinal cord injury continues to be a topic of debate. This controversy largely stems from fundamental issues in statistical interpretation of trial data, most notably subgroup analyses. The purpose of this review is to discuss important examples of improper subgroup analysis and encourage better practices in future research
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