JAMA. Published online May 8, 2020. doi:10.1001/jama.2020.3508
Understanding whether the results of a randomized clinical trial (RCT) are clinically actionable is challenging. Reporting standards adopted byJAMAand other leading journals lead to relative uniformity of presentation of RCT findings that help simplify critical appraisal.1Such uniform reporting also means that the conclusion of the trial may be dichotomized as “positive” or “no difference” based on the statistical significance of the primary outcome. Dichotomization based on the statistical significance of the primary outcome variable reflects the correct, albeit narrow, interpretation of the experiment that the RCT represents. It also reflects decisions made by the investigators in the design of the study and highlights findings in relation to prespecified assumptions. However, there are situations in which a broader appreciation of the results may suggest that non–statistically significant results in the primary outcome of a clinical trial could influence and perhaps change practice. This includes consideration of the outcome in terms of effect size and accompanying CIs, placing the findings from the trial in the context of the totality of the existing relevant evidence.
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