Gambling with ethics? A statistical note on the Poisson (binomial) distribution

Pandit, J. J.

doi:10.1111/j.1365-2044.2008.05729.x

Cited by 39 publications

(43 citation statements)

References 23 publications

(19 reference statements)

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“…Data are quoted with 95% Poisson confidence intervals [30], and chisquared testing reserved for some comparisons of certain/probable AAGA frequencies (the most complete dataset).…”

Section: Methodsmentioning

confidence: 99%

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

et al. 2014

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SummaryWe present the main findings of the 5th National Audit Project on accidental awareness during general anaesthesia. Incidences were estimated using reports of accidental awareness as the numerator, and a parallel national anaesthetic activity survey to provide denominator data. The incidence of certain/probable and possible accidental awareness cases was ~1:19 600 anaesthetics (95% CI 1:16 700–23 450). However, there was considerable variation across subtypes of techniques or subspecialties. The incidence with neuromuscular blockade was ~1:8200 (1:7030–9700), and without it was ~1:135 900 (1:78 600–299 000). The cases of accidental awareness during general anaesthesia reported to 5th National Audit Project were overwhelmingly cases of unintended awareness during neuromuscular blockade. The incidence of accidental awareness during caesarean section was ~1:670 (1:380–1300). Two thirds (82, 66%) of cases of accidental awareness experiences arose in the dynamic phases of anaesthesia, namely induction of and emergence from anaesthesia. During induction of anaesthesia, contributory factors included: use of thiopental; rapid sequence induction; obesity; difficult airway management; neuromuscular blockade; and interruptions of anaesthetic delivery during movement from anaesthetic room to theatre. During emergence from anaesthesia, residual paralysis was perceived by patients as accidental awareness, and commonly related to a failure to ensure full return of motor capacity. One third (43, 33%) of accidental awareness events arose during the maintenance phase of anaesthesia, most due to problems at induction or towards the end of anaesthesia. Factors increasing the risk of accidental awareness included: female sex; age (younger adults, but not children); obesity; anaesthetist seniority (junior trainees); previous awareness; out‐of‐hours operating; emergencies; type of surgery (obstetric, cardiac, thoracic); and use of neuromuscular blockade. The following factors were not risk factors for accidental awareness: ASA physical status; race; and use or omission of nitrous oxide. We recommend that an anaesthetic checklist, to be an integral part of the World Health Organization Safer Surgery checklist, is introduced as an aid to preventing accidental awareness. This paper is a shortened version describing the main findings from 5th National Audit Project – the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home#pt.

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“…Data are quoted with 95% Poisson confidence intervals [30], and chisquared testing reserved for some comparisons of certain/probable AAGA frequencies (the most complete dataset).…”

Section: Methodsmentioning

confidence: 99%

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

et al. 2014

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“…In a groundbreaking book entitled the 'Law of Small Numbers' (a phrase that still resonates in statistical circles) [3], he showed that the data followed the 'Poisson distribution' (Fig. 1), the mathematics of which have been discussed several times previously in the pages of this journal [4][5][6].…”

Section: What Does the Poisson Distribution Imply?mentioning

confidence: 99%

Deaths by horsekick in the Prussian army - and other ‘Never Events’ in large organisations

Pandit

2015

Anaesthesia

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“…Case-control studies at Level 3b can be adequately powered (e.g. using the Poisson distribution for observational data [27]) and (as discussed above) data from historical controls can be used in a non-inferiority design to set the margins of acceptability. Traditionally used to monitor the progress of disease, such study designs can also be adapted to examine interventions such as use of airway management devices.…”

Section: What Sort Of 'Evidence' Is Needed?mentioning

confidence: 99%

The Difficult Airway Society ‘ADEPT’ Guidance on selecting airway devices: the basis of a strategy for equipment evaluation

et al. 2011

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SummaryFaced with the concern that an increasing number of airway management devices were being introduced into clinical practice with little or no prior evidence of their clinical efficacy or safety, the Difficult Airway Society formed a working party (Airway Device Evaluation Project Team) to establish a process by which the airway management community within the profession could itself lead a process of formal device/equipment evaluation. Although there are several national and international regulations governing which products can come on to the market and be legitimately sold, there has hitherto been no formal professional guidance relating to how products should be selected (i.e. purchased). The Airway Device Evaluation Project Team’s first task was to formulate such advice, emphasising evidence‐based principles. Team discussions led to a definition of the minimum level of evidence needed to make a pragmatic decision about the purchase or selection of an airway device. The Team concluded that this definition should form the basis of a professional standard, guiding those with responsibility for selecting airway devices. We describe how widespread adoption of this professional standard can act as a driver to create an infrastructure in which the required evidence can be obtained. Essential elements are that: (i) the Difficult Airway Society facilitates a coherent national network of research‐active units; and (ii) individual anaesthetists in hospital trusts play a more active role in local purchasing decisions, applying the relevant evidence and communicating their purchasing decisions to the Difficult Airway Society.

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Gambling with ethics? A statistical note on the Poisson (binomial) distribution

Cited by 39 publications

References 23 publications

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

Deaths by horsekick in the Prussian army - and other ‘Never Events’ in large organisations

The Difficult Airway Society ‘ADEPT’ Guidance on selecting airway devices: the basis of a strategy for equipment evaluation

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