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1Formulas and methods
Evidence-based practice statistics
Sensitivity and specificity
Se = a/(a + c), Sp = d/(b + d)
Predictive values
PPV = a/(a + b), NPV = d/(c + d)
Accuracy
(a + d)/n
Likelihood ratios
LR+ = Se/(1 − Sp), LR− = (1 − Se)/Sp
PPV at prevalence p
Se·p / (Se·p + (1 − Sp)(1 − p))
Odds
odds = p/(1 − p); p = odds/(1 + odds); post-test odds = pre-test odds × LR
Risk measures
RR = EER/CER, ARR = CER − EER, RRR = ARR/CER
Number needed to treat
NNT = 1/ARR, rounded up; NNH = 1/(EER − CER)
Odds ratio
OR = ad/(bc)
Incidence rate
new cases / person-time
Method
Draw the 2 × 2 table and label a, b, c and d before you calculate.
Read sensitivity and specificity down the columns, predictive values along the rows.
For another prevalence, imagine 10 000 people and fill the table with Se, Sp and the prevalence.
For a likelihood ratio, convert the probability to odds, multiply, and convert back.
For a trial, find EER and CER first; then RR = EER/CER, ARR = CER − EER and NNT = 1/ARR rounded up.
Descriptive statistics
Mean
x̄ = Σx/n
Sample standard deviation
s = √(Σ(x − x̄)²/(n − 1))
Median
middle value of the sorted data
z-score
z = (x − μ)/σ
Normal distribution
68% within ±1σ, 95% within ±2σ
Confidence intervals
σ known
x̄ ± z·σ/√n
σ unknown
x̄ ± t·s/√n, df = n − 1
Critical z
90%: 1.645, 95%: 1.96, 99%: 2.576
Sample size
n = (z·σ/E)², rounded up
Method
Decide between z (population σ known) and t (only the sample s, with n − 1 degrees of freedom).
Find the critical value for the confidence level.
Margin of error: E = critical value × standard deviation/√n.
Interval: x̄ ± E.
Hypothesis tests & confidence intervals
z-test for a mean
z = (x̄ − μ0)/(σ/√n)
t-test for a mean
t = (x̄ − μ0)/(s/√n), df = n − 1
Two-sided at 5%
reject H0 if |z| > 1.96
Confidence interval
x̄ ± z·σ/√n
Method
State H₀ and H₁ and decide whether the test is one- or two-sided.
Calculate the test statistic: (x̄ − μ₀)/(σ/√n), or with s and t.
Compare with the critical value, or find the p-value.
Reject H₀ if the statistic is beyond the critical value (p below α), and state the conclusion in words.
2Practice problems
1.Evidence-based practice statisticsMedium
Practice exercise (made-up values, not clinical guidance). A new test was compared with the reference standard in a study (see the 2 × 2 table). Find the positive likelihood ratio LR+. Round to two decimal places.
a = 46b = 277c = 24d = 1573
LR+ =
2.Evidence-based practice statisticsHard
Practice exercise (made-up values, not clinical guidance). A patient has a pre-test probability of 25% for a disease. A test with sensitivity 62% and specificity 78% comes back negative. Find the post-test probability p′ of the disease as a percentage. Round to one decimal place.
pre-test 25%Se = 62%Sp = 78%negative
p′ = %
3.Descriptive statisticsMedium
Find the sample standard deviation s of the data: 42, 13, 52, 24, 51, 55, 16.
n = 7
s =
4.Descriptive statisticsHard
Exam scores are normally distributed with mean 50 and standard deviation 8. Find the z-score z of a score of 66.
μ = 50σ = 8x = 66
z =
5.Confidence intervalsMedium
A 99% confidence interval for a mean, based on 36 observations and a known σ, has a margin of error of 2.3. What is the margin of error E₂ of a 95% interval based on 324 observations?
99%n₁ = 36E₁ = 2.395%n₂ = 324
E₂ =
6.Confidence intervalsHard
The population standard deviation is 32. How large a sample n do you need so that a 99% confidence interval for the mean has a margin of error of at most 4?
σ = 32E = 499%
n =
7.Hypothesis tests & confidence intervalsMedium
10 employees take a typing test before and after a training course. For each person the difference d = after − before (words per minute) is recorded. The mean difference is 6.24 and the standard deviation of the differences is 9.4. Find the paired test statistic t for H₀: μd = 0.
n = 10d̄ = 6.24sd = 9.4
t =
8.Hypothesis tests & confidence intervalsHard
How large must a sample be so that the 95% confidence interval for a mean has a margin of error of at most 3? The standard deviation is 10. Find the smallest sample size n.
σ = 10E = 395%
n =
3Solutions
1.Evidence-based practice statistics
Answer: LR+ = 4.39
Likelihood ratios and risk measures: LR+ = sensitivity/(1 − specificity), LR− = (1 − sensitivity)/specificity. In a trial, EER and CER are the event rates with and without treatment: RR = EER/CER, ARR = CER − EER, RRR = ARR/CER and NNT = 1/ARR, rounded up. In a case-control study only the odds ratio OR = ad/(bc) can be used. An incidence rate = new cases/person-time.
Sensitivity and specificity
Se = 46/70 = 0.6571
Sp = 1573/1850 = 0.8503
Positive likelihood ratio
LR+ = 0.6571/(1 − 0.8503) = 4.389 ≈ 4.39
Answer
LR+ = 4.39
2.Evidence-based practice statistics
Answer: p′ = 14 %
Predictive values depend on prevalence: PPV = Se·p/(Se·p + (1 − Sp)(1 − p)) and NPV = Sp(1 − p)/(Sp(1 − p) + (1 − Se)p). With likelihood ratios: pre-test odds = p/(1 − p), post-test odds = pre-test odds × LR, probability = odds/(1 + odds). For a population of N, true positives = N·p·Se and false positives = N·(1 − p)·(1 − Sp). NNT = 1/(CER × RRR), rounded up.
Likelihood ratio
LR− = (1 − 0.62)/0.78 = 0.4872
Pre-test odds
0.25/(1 − 0.25) = 0.3333
Post-test odds
0.3333·0.4872 = 0.1624
Post-test probability
p′ = 0.1624/(1 + 0.1624) = 0.1397 ≈ 14%
Answer
p′ = 14%
3.Descriptive statistics
Answer: s = 18.03
Descriptive statistics: the mean is the sum divided by n; the median is the middle value of the sorted data (the average of the two middle values when n is even). The sample standard deviation is s = √(Σ(x − x̄)²/(n − 1)). A z-score z = (x − μ)/σ says how many standard deviations a value lies from the mean.
Descriptive statistics: the mean is the sum divided by n; the median is the middle value of the sorted data (the average of the two middle values when n is even). The sample standard deviation is s = √(Σ(x − x̄)²/(n − 1)). A z-score z = (x − μ)/σ says how many standard deviations a value lies from the mean.
Standardise
z = (66 − 50)/8 = 2
Answer
z = 2
5.Confidence intervals
Answer: E₂ = 0.5833
Confidence interval for a mean: x̄ ± margin of error. With a known population σ the margin is z·σ/√n; with only the sample standard deviation s, use t with n − 1 degrees of freedom: t·s/√n. Critical values: z = 1.645 (90%), 1.96 (95%), 2.576 (99%). To get a margin E or smaller, you need n ≥ (z·σ/E)², rounded up.
Ratio of margins
E₂/E₁ = (1.96/2.576)·√(36/324) = 0.2536
New margin
E₂ = 2.3·0.2536 = 0.5833
Answer
E₂ = 0.5833
6.Confidence intervals
Answer: n = 425
Confidence interval for a mean: x̄ ± margin of error. With a known population σ the margin is z·σ/√n; with only the sample standard deviation s, use t with n − 1 degrees of freedom: t·s/√n. Critical values: z = 1.645 (90%), 1.96 (95%), 2.576 (99%). To get a margin E or smaller, you need n ≥ (z·σ/E)², rounded up.
Solve for n
n = (2.576·32/4)² = 424.7
Round up
A sample size is a whole number, and rounding down would make the margin too large.
n = 425
Answer
n = 425
7.Hypothesis tests & confidence intervals
Answer: t = 2.099
Testing a mean: the test statistic measures how many standard errors the sample mean lies from the value claimed in H₀: z = (x̄ − μ₀)/(σ/√n) when σ is known, t = (x̄ − μ₀)/(s/√n) when it is estimated from the sample. A confidence interval is x̄ ± (critical value)·(standard error).
Standard error of the mean difference
SE = 9.4/√10 = 2.973
Test statistic
t = 6.24/2.973 = 2.099
Answer
t = 2.099
With df = 9, the two-sided 5% critical value is 2.262; |t| is smaller, so H₀ is not rejected.
8.Hypothesis tests & confidence intervals
Answer: n = 43
Testing a mean: the test statistic measures how many standard errors the sample mean lies from the value claimed in H₀: z = (x̄ − μ₀)/(σ/√n) when σ is known, t = (x̄ − μ₀)/(s/√n) when it is estimated from the sample. A confidence interval is x̄ ± (critical value)·(standard error).