Single Versus Double-Sided Hypotheses and Probabilities.

Single-sided (1-tailed) and double-sided (2-tailed) probabilities are products of statistical tests that can be crucial to drawing accurate conclusions in scientific studies. In a review of articles published in issues of Pediatric Emergency Care from 2020, we identified 2 where single-sided versus double-sided probability issues potentially reversed a conclusion of study investigators. The purpose of this study is to describe single-sided versus double-sided probability issues found in Pediatric Emergency Care 2020 articles to increase awareness surrounding these issues. METHODS: This study involved a review of all articles from 2020 issues of the Pediatric Emergency Care journal, examining whether P values between and including the values 0.05 and 0.10, were characterized as not significant when, in fact, they resulted from a double-sided test and arguably should have been halved to yield significant single-sided probabilities less than or equal to 0.05. RESULTS: Two such studies were identified. In the first study, researchers concluded that their intervention resulted in "no statistically significant improvement," citing a P value of 0.08, but if a single-sided P value was used, it would have been 0.04 and the authors would have instead concluded that their intervention resulted in significant improvement. In the second study, researchers measured resuscitation times in pediatric and adult manikin simulations. They concluded no difference, citing a P value of 0.088, but if a single-sided P value was used, it would have been 0.044, and the authors would have instead concluded that the resuscitation times took longer in the pediatric simulation. CONCLUSIONS: These articles demonstrate how single-sided versus double-sided probability issues can cause researchers to draw inaccurate conclusions. As such, we would urge that this be more rigorously evaluated when the P values are between 0.05 and 0.10.

Patient/parent administered epinephrine in acute anaphylaxis.

BACKGROUND: Among patients with a known peanut allergy, previous studies suggest low carrying rates of epinephrine auto-injectors (EAIs) and hesitancy to self-administer epinephrine upon anaphylaxis onset. Given the high prescription rates of epinephrine and prevalence of peanut allergies, it is important to identify rates of on-scene EAI use and affecting factors. METHODS: The electronic medical records of 217 patients-either with an ED diagnosis of peanut anaphylaxis or diagnosis of anaphylaxis with a known epinephrine prescription from 2010 through May 2020--were reviewed for physician notes and demographic factors. RESULTS: Epinephrine was administered on-scene by 25.3% of anaphylaxis patients. Of the 6 health care professionals identified, 100% administered epinephrine on-scene. Females (32.2%) were administered epinephrine on-scene more frequently than males (19.8%; p = 0.04). Rate of epinephrine administration increased from 2010 through 2019 (p = 0.005). CONCLUSION: This study selected for individuals diagnosed with anaphylaxis, meaning EAI use should have been observed nearly 100% of the time. An administration rate of 22.6% observed among individuals not identified as health care professionals suggests that the majority of patients prescribed epinephrine have not used their EAIs, even when presented an opportunity for application. The administration rate of 100% observed among health care professionals indicates that comfort with EAIs facilitates willingness to administer on-scene. EAIs can range up to $900 in expense, thus physicians should employ EAI training devices and other training strategies.