Regression discontinuity was a valid design for dichotomous outcomes in three randomized trials

Journal of Clinical Epidemiology
Nikki van LeeuwenEwout W Steyerberg

Abstract

Regression discontinuity (RD) is a quasi-experimental design that may provide valid estimates of treatment effects in case of continuous outcomes. We aimed to evaluate validity and precision in the RD design for dichotomous outcomes. We performed validation studies in three large randomized controlled trials (RCTs) (Corticosteroid Randomization After Significant Head injury [CRASH], the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries [GUSTO], and PROspective Study of Pravastatin in elderly individuals at risk of vascular disease [PROSPER]). To mimic the RD design, we selected patients above and below a cutoff (e.g., age 75 years) randomized to treatment and control, respectively. Adjusted logistic regression models using restricted cubic splines (RCS) and polynomials and local logistic regression models estimated the odds ratio (OR) for treatment, with 95% confidence intervals (CIs) to indicate precision. In CRASH, treatment increased mortality with OR 1.22 [95% CI 1.06-1.40] in the RCT. The RD estimates were 1.42 (0.94-2.16) and 1.13 (0.90-1.40) with RCS adjustment and local regression, respectively. In GUSTO, treatment reduced mortality (OR 0.83 [0.72-0.95]), with more extre...Continue Reading

Citations

Aug 1, 2020·Journal of Dental Research·U CoorayK Osaka
Jul 28, 2020·The American Journal of Clinical Nutrition·Christian BommerSebastian Vollmer
Mar 4, 2021·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Ewout W SteyerbergPatrick M M Bossuyt

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