{"id":997,"date":"2014-10-20T21:01:56","date_gmt":"2014-10-20T20:01:56","guid":{"rendered":"https:\/\/blogs.bmj.com\/adc\/?p=997"},"modified":"2014-10-10T09:22:34","modified_gmt":"2014-10-10T08:22:34","slug":"guest-blog-sampling-bias-and-randomisation","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/adc\/2014\/10\/20\/guest-blog-sampling-bias-and-randomisation\/","title":{"rendered":"Guest Blog: Sampling bias and randomisation"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"http:\/\/adc.bmj.com\/content\/99\/10.cover.gif\" alt=\"\" width=\"73\" height=\"96\" \/>The blog\u00a0series is expanding!\u00a0No<a title=\"Archives of Disease in Childhood\u2019s Twitter Journal Club \u2013 #ADC_JC\" href=\"https:\/\/blogs.bmj.com\/adc\/twitterclub\/\"> doubt soley inspired by now running the magnificent @ADC_JC<\/a>, <a href=\"http:\/\/twitter.com\/davidking83\">@davidking83<\/a> has taken up the challenge of exploring a critical appraisal nugget\/thorn in response to an appraisal session.<\/p>\n<p>You too could be part of our team\u00a0&#8211; tweet <a href=\"http:\/\/twitter.com\/ADC_BMJ\">@ADC_BMJ<\/a> or <a href=\"https:\/\/www.facebook.com\/ADC.BMJ\">find us on Faceboo<\/a>k to get in touch &#8211; but for now, let&#8217;s settle back, imaging the warm smell of pastries and coffee, switch off our pagers and enter the Journal Club&#8230;<\/p>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter\" src=\"http:\/\/www.sheffieldchildrens.nhs.uk\/getimage.aspx.ID-260080.width-263.jpg\" alt=\"\" width=\"263\" height=\"153\" \/><\/p>\n<p>We were recently discussing a paper in my<a href=\"http:\/\/www.sheffieldchildrens.nhs.uk\/our-services\/library\/journal-club\/\"> local journal club at Sheffield Children\u2019s hospital<\/a>,which was a double-blind randomised controlled trial (RCT) examining the effect of pulse oximetry on the admission rate of infants with mild or moderate bronchiolitis. This is a fascinating <a href=\"http:\/\/jama.jamanetwork.com\/article.aspx?articleid=1896981\">paper<\/a> and well worth a read if you have not already. Essentially, it showed that in infants with mild to moderate bronchiolitis, clinicians are less likely to admit children if their oxygen saturations are artificially raised by 3%.<\/p>\n<p>However, one of the points raised from the journal club was the possible effect of selection bias on the results of the trial. The authors state that the parents of a large number of eligible infants refused to take part and this may have introduced selection bias.<\/p>\n<p>The question was raised as to if this made\u00a0the study less valid.<\/p>\n<a name=\"pd_a_8364958\"><\/a>\n<div class=\"CSS_Poll PDS_Poll\" id=\"PDI_container8364958\" style=\"display:inline-block;\"><\/div>\n<div id=\"PD_superContainer\"><\/div>\n<script type=\"text\/javascript\" charset=\"UTF-8\" src=\"https:\/\/static.polldaddy.com\/p\/8364958.js\"><\/script>\n<noscript><a href=\"https:\/\/poll.fm\/8364958\">Take Our Poll<\/a><\/noscript>\n<p><!--more--><\/p>\n<p>Part of the problem here, is exactly what is meant by selection bias. It&#8217;s mainly used to describe the selection of patients to receive a therapy &#8211; so in the context of an RCT, preferentially allocating patients with similar prognostic factors to the same arm of the clinical trial. This would result in a treatment appearing more or less effective than it actually is. In the trial mentioned above, an example of this type of selection bias would be deliberately allocating more babies with mild rather than moderate respiratory distress to the group with falsely elevated oxygen saturations.<\/p>\n<p>True randomisation, followed by good allocation concealment, by definition, should not allow this to occur. A properly double-blind RCT \u00a0will have and this type of selection bias should therefore be eliminated in a double-blind RCT. However, there is a subtype of selection bias, known as \u2018sampling bias\u2019 which could create problems. To stick with this paper, hypothetically it could be that the study was only performed in infants with oxygen saturations of &gt;95%, mild respiratory distress and in families with non-smokers as these were the people most likely to agree to take part in the research study*. This would make the results less generalisable to your own population but otherwise it does not affect the validity of the results.<\/p>\n<p>&nbsp;<\/p>\n<p>In summary, providing randomisation and blinding has occurred properly in a double-blind RCT most types of selection bias should not be a problem. However, sampling bias and therefore whether the results are generalisable to your own population, is something of which you need to be wary.<\/p>\n<p>&nbsp;<\/p>\n<p>* the study population was actually much more representative of patients with mild to moderate bronchiolitis than in this example<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The blog\u00a0series is expanding!\u00a0No doubt soley inspired by now running the magnificent @ADC_JC, @davidking83 has taken up the challenge of exploring a critical appraisal nugget\/thorn in response to an appraisal session. You too could be part of our team\u00a0&#8211; tweet @ADC_BMJ or find us on Facebook to get in touch &#8211; but for now, let&#8217;s [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/adc\/2014\/10\/20\/guest-blog-sampling-bias-and-randomisation\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2677,2676],"tags":[],"class_list":["post-997","post","type-post","status-publish","format-standard","hentry","category-adc_jc","category-stats"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Guest Blog: Sampling bias and randomisation - ADC Online Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/adc\/2014\/10\/20\/guest-blog-sampling-bias-and-randomisation\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Guest Blog: Sampling bias and randomisation - ADC Online Blog\" \/>\n<meta property=\"og:description\" content=\"The blog\u00a0series is expanding!\u00a0No doubt soley inspired by now running the magnificent @ADC_JC, @davidking83 has taken up the challenge of exploring a critical appraisal nugget\/thorn in response to an appraisal session. 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