Discrepancies in sample size calculations and data analyses reported in randomised trials: comparison of publications with protocols
Open accessAbstract
OBJECTIVE: To evaluate how often sample size calculations and methods of statistical analysis are pre-specified or changed in randomised trials. DESIGN: Retrospective cohort study. Data source Protocols and journal publications of published randomised parallel group trials initially approved in 1994-5 by the scientific-ethics committees for Copenhagen and Frederiksberg, Denmark (n=70). MAIN OUTCOME MEASURE: Proportion of protocols and publications that did not provide key information about sample size calculations and statistical methods; proportion of trials with discrepancies between information presented in the protocol and the publication. RESULTS: Only 11/62 trials described existing sample size calculations fully and consistently in both the protocol and the publication. The method of handling protocol deviations was described in 37 protocols and 43 publications. The method of handling missing data was described in 16 protocols and 49 publications. 39/49 protocols and 42/43 publications reported the statistical test used to analyse primary outcome measures. Unacknowledged discrepancies between protocols and publications were found for sample size calculations (18/34 trials), methods of handling protocol deviations (19/43) and missing data (39/49), primary outcome analyses (25/42), subgroup analyses (25/25), and adjusted analyses (23/28). Interim analyses were described in 13 protocols but mentioned in only five corresponding publications. CONCLUSION: When reported in publications, sample size calculations and statistical methods were often explicitly discrepant with the protocol or not pre-specified. Such amendments were rarely acknowledged in the trial publication. The reliability of trial reports cannot be assessed without having access to the full protocols.
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The interpretation of trial results in published reports is not always consistent with the prespecified conceptual framework.
“In addition, the interpretation of trial results in published reports is not always consistent with the prespecified conceptual framework,198 199 200 especially among reports claiming post hoc equivalence based on a failure to show superiority, rather than on a specific test of equivalence.198”
From SPIRIT 2025 explanation and elaboration: updated guideline for protocols of randomised trials (2025) · cites this paper as [200]
Among randomised trial protocols that describe a sample size calculation, studies often do not state all components necessary to understand and reproduce the sample size (including the derivation of the target difference and the source of estimated values).
“Among randomised trial protocols that describe a sample size calculation, studies often do not state all components necessary to understand and reproduce the sample size (including the derivation of the target difference and the source of estimated values).200 297”
From SPIRIT 2025 explanation and elaboration: updated guideline for protocols of randomised trials (2025) · cites this paper as [200]
These substantive modifications are rarely acknowledged in the final trial reports.
“These substantive modifications are rarely acknowledged in the final trial reports.200 249 250 480”
From SPIRIT 2025 explanation and elaboration: updated guideline for protocols of randomised trials (2025) · cites this paper as [200]
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- Authors
- Chan, A.-W., Hrobjartsson, A., Jorgensen, K. J., Gotzsche, P. C., & Altman, D. G.
- Affiliations
- Mayo Clinic (US)
- Cochrane (DK)
- University of Oxford (GB)
- Corresponding author
- Chan, A.-W.
- ORCID
- Altman, D. G
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2008-12-04
- Volume
- 337
- Issue
- dec04 1
- Pages
- a2299-a2299
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC2600604
- OpenAlex
- W2074736802
- Cited by
- 202
- References
- 59
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 9 · 2023: 9 · 2022: 10 · 2021: 15 · 2020: 16 · 2019: 6 · 2018: 15 · 2017: 11 · 2016: 10 · 2015: 9 · 2014: 14 · 2013: 9 · 2012: 16
- FWCI
- 17.02
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion, cc-by)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmaceutical industry and healthcare
- Keywords
- sample size determination, statistical methods reporting, randomized controlled trials, missing data handling, protocol deviations, subgroup analysis, interim analysis
- MeSH terms
- Data Collection, Data Interpretation, Statistical, Publishing, Retrospective Studies, Cohort Studies, Randomized Controlled Trials as Topic, Sample Size
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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