SPECIAL CONTRIBUTION

biostatistics

Introduction to Biostatistics: Part 4,

Statistical Inference Techniques in
Hypothesis Testing

Statistical methods used to test the null hypothesis are termed tests of Gary M Caddis, MD, PhD*
significance. Selection of an appropriate test of significance is dependent Monica L G~tddis, PhDt
on the type of data to be analyzed and the number of groups to be com- Kansas City, Missouri
pared. Parametric tests of significance are based on the parameters, mean,
standard deviation, and variance, and thus are used appropriately when From the Departments of Emergency
interval or ratio data are analyzed. The t-test and analysis of variance Health Services* and Surgery,t Truman
Medical Center, University of Missouri-
(ANOVA) are examples of parametric tests of significance. Assumptions Kansas City School of Medicine.
regarding the data to be analyzed when using the t-test or ANOVA include
normality of the populations from which the sample data are drawn, ho-
Received for publication September 1,
mogeneity of the variances of the populations from which the sample data
1989. Accepted for publication
are drawn, and independence of the data points within a sample group. March 30, 1990.
The t-test is the appropriate test of significance to use if there are only two
groups to compare. If there are three or more groups to compare, ANOVA is Address for reprints: Monica L Caddis,
the appropriate test. ANOVA holds the preset c~ level constant. While PhD, Department of Surgery, Truman
ANOVA will imply a significant difference between the groups compared, Medical Center, 2301 Holmes, Kansas
a multiple comparison test will define which of the three or more groups City, Missouri 64108.
differ significantly. [Gaddis GM, Gaddis ML: Introduction to biostatistics:
Part 4, statistical inference techniques in hypothesis testing. Ann Emerg
Med July 1990;19:820-825.]

INTRODUCTION
The research process follows an organized, stepwise pattern. A problem
is identified, the research hypothesis is generated, methods of data collec-
tion are devised, and the statistical analysis of the data to be collected is
designed. Calculation of measures of central tendency and variability are
easily completed, but alone these numbers have only descriptive value.
Making a decision to reject or accept the null hypothesis (Ho) requires
much more extensive statistical analysis of the data.
Statistical methods used to test the null or statistical hypothesis (Ho) are
termed tests of significance. 1 Recall from Part 3 of this series [May
1990;19:591-597] that hypothesis testing involves accepting or rejecting
He .2 Selection of an appropriate test of significance is dependent on several
factors, including the number of groups to be compared and the type of
data to be analyzed. This fourth in the series of six articles will address the
concepts of parametric statistical inference techniques in hypothesis test-
ing.

PARAMETRIC VERSUS NONPARAMETRIC METHODS

The mean and the standard deviation (SD) of a population describe a
normally distributed population. 3 (Because the SD is computed as the
square root of the variance, it can also be said that the variance also de-
scribes a normal distribution.) Not only are the mean, median, and mode
equal in a normal distribution of data, but known percentages of data fall
within set SDs from the mean with a normally distributed set of data. The
mean, SD, and variance of a population are termed parameters of that pop-
ulation. Parametric statistical methods are based on these parameters. 1
Thus, given the relationship between these parameters and normality, the
underlying assumption of parametric statistical methods is that the data
being analyzed are normally distributed. If the data are not normally dis-
tributed and cannot be defined as interval or ratio data, other statistical

19:7 July 1990 Annals of Emergency Medicine 820/137

BIOSTATISTICS
Gaddis & Gaddis

Set a level

Planned I Ftest
comparisons

I
Control of experiment-I
wise error rate? I
I

I Yes I No

(
I Experimentwise LSD
method Layer method
J test

I Small or large number

of contrasts
Contrasts with
control only
I I Newman-Keuls
test Duncan test

Small I Large I

Dunn test
I
I More than two means J I Dunnetttest
involved in contrast

No Yes L
I
Tukey test
II Scheff~ test

FIGURE. Flow chart for multiple
comparison decisions (adapted from
Hopkins and Chadboum [1967] and
Keppel [1973]).
methods appropriately termed non-
parametric statistical methods are
used.
138/821
In addition to differences in type of
data analyzed and the assessment of
normality of the data, there are other
characteristics possessed by these
two classifications of statistical tests
that illustrate their inherent differ-
ences. First, parametric tests prove to
be m o r e p o w e r f u l t h a n n o n -
parametric tests. That is, if a differ-
Annals of EmergencyMedicine
ence between groups truly exists, all
else being the same, that difference
would more likely be found using the
parametric test. Furthermore, more
, information about the data is gener-
ated from parametric tests.1 However
important these differences are, the
nonparametric statistical test should
not be discounted. Because not all
19:7 July 1990
data are n o r m a l l y distributed and not
all are of an i n t e r v a l or r a t i o scale,
nonparametric methods that are
sound in their m a t h e m a t i c a l theory
often offer the only l e g i t i m a t e m e a n s
of data analysis available.
PARAMETRIC STATISTICAL
INFERENCE TESTS
t-Test
S t u d e n t ' s t-test (t-test) is the pa-
rametric statistical method with
w h i c h researchers are m o s t often fa-
miliar. It is certainly the m o s t com-
m o n s t a t i s t i c a l m e t h o d r e p o r t e d in
the m e d i c a l literature. 1 The t-test is
used to accept or reject H o. It is sim-
plistic in that a comparison b e t w e e n
two groups can be m a d e and a deci-
sion rendered w i t h o u t further analy-
sis. Yet the t-test is powerful; it is a
parametric method that mathe-
m a t i c a l l y and t h e o r e t i c a l l y is based
on the means, SDs, and variances of
the data.
The t-test also requires that several
a s s u m p t i o n s r e g a r d i n g t h e d a t a be
m a d e prior to use. If the data do not
m e e t the assumptions, then the t-test
is n o t the appropriate m e t h o d to use.
A s s u m p t i o n s of the t-test include the
following: 1) T h e p o p u l a t i o n s f r o m
which the samples were drawn
s h o u l d a p p r o a c h a n o r m a l distribu-
tion; 2) the variances of the popula-
tions from w h i c h sample 1 and sam-
ple 2 were drawn should be equal or
nearly equal; and 3) the observations
within a p o p u l a t i o n or sample group
s h o u l d be i n d e p e n d e n t , ie, " n o t
paired, matched, correlated, or inter-
dependent in any way. ''4
W h i l e t h e s e a s s u m p t i o n s are im-
portant, the t-test is robust enough to
be an appropriate test if an assump-
tion is n o t m e t in the strictest sense
( e x c e p t i n g t h e a s s u m p t i o n of i n d e -
pendence, w h i c h m u s t be m e t at all
times).4, s However, this is n o t to say
that it is appropriate to use the t-test
for n o m i n a l or o r d i n a l data or data
that do n o t come from a n o r m a l l y or
near-normally distributed popula-
tion.
W h i l e the t-test is used to compare
two sample groups, the e x p e r i m e n t a l
design of the study m u s t be consid-
ered b e c a u s e n o t all t-tests are the
same. Consideration of the following
is i m p o r t a n t : 1) Are the observations
between g r o u p s i n d e p e n d e n t (as is
the case for a control vs e x p e r i m e n t a l
group design), so t h a t a nonpaired
t - t e s t is appropriate? 2) Are the ob-
19:7 July 1990
servations between groups d e p e n d e n t
(as is the case for a p r e t e s t / p o s t - t e s t
design), so that a paired t-test is ap-
propriate? 3) Are the groups equal or
unequal in size? 4) Is the c o m p a r i s o n
b e t w e e n a p o p u l a t i o n m e a n and sam-
p l e m e a n or b e t w e e n t w o s a m p l e
means? 5) Is t h e direction of the dif-
ference between the two groups
k n o w n or unknown? If a direction of
difference is postulated, the t-test is
t e r m e d a or~e-tailed test. If no direc-
tion of difference is p o s t u l a t e d , t h e
t-test is t e r m e d two-tailed.
A very c o m m o n e x p e r i m e n t a l de-
sign in t h e medical l i t e r a t u r e is a sit-
u a t i o n in w h i c h there are two differ-
e n t i n d e p e n d e n t groups, a c o n t r o l
group and an e x p e r i m e n t a l group.
For example, suppose a n e w drug is
being tested to see if it will decrease
arterial pressure in persons w i t h hy-
pertension. Two sample groups
w o u l d be selected by r a n d o m assign-
ment. Group 1 will receive a placebo
while group 2 will receive the drug in
question. The alpha (cx) level is pre-
set. (Because the drug in question is
h y p o t h e s i z e d to l o w e r arterial pres-
sure, a direction of change is postu-
lated, and this data should be tested
by a one-tailed t-test.) T h e data are
c o l l e c t e d , d e s c r i p t i v e s t a t i s t i c s are
calculated, and the t v a l u e is coin-
puted. T h e t-test calculation is easily
referenced. 4-6
Once a t value is obtained, the re-
s e a r c h e r s h o u l d c o n s u l t a t a b l e of
critical values for t w i t h the appro-
priate c~ level and degrees of freedom.
If t h e c a l c u l a t e d t v a l u e is g r e a t e r
than the critical t, H o is rejected and
it is c o n c l u d e d t h a t the m e d i c a t i o n
in question does lower diastolic arte-
rial pressure in hypertensives. If t h e
c a l c u l a t e d t v a l u e is less t h a n t h e
critical t, H o is accepted as tenable.
A n o t h e r experimental design com-
m o n to the medical literature is t h e
p r e t e s t / p o s t - t e s t design. This results
in dependent or related data b e t w e e n
groups (repeated measure) and is an-
alyzed using the paired t-test.
For e x a m p l e , a n e w t h r o m b o l y t i c
agent is developed that is p o s t u l a t e d
to halt the progression of a myocar-
dial infarction. Patients entering t h e
emergency department with an
evolving myocardial infarction un-
dergo D o p p l e r e c h o c a r d i o g r a p h y to
assess e j e c t i o n f r a c t i o n . F o l l o w i n g
this procedure, the experimental
t h r o m b o l y t i c agent is a d m i n i s t e r e d .
Two days later, e j e c t i o n fraction is
Annals of Emergency Medicine
assessed again. Pre- and post-throm-
bolytic a d m i n i s t r a t i o n data are c o m -
pared using a paired t-test so that pa-
t i e n t s serve as t h e i r o w n c o n t r o l s .
T h e l a c k of a significant difference
between pre- and post-treatment
e j e c t i o n f r a c t i o n e s t i m a t e s is ex-
pected if the drug is efficacious.
The t-test is the m e t h o d of choice
when making a single comparison
b e t w e e n two groups whose data m e e t
the a s s u m p t i o n s required of parame-
tric analysis methods. However,
w h a t is done if the e x p e r i m e n t a l de-
sign consists of three or m o r e groups
to be compared? T h e researcher m a y
incorrectly compare these groups
using several t-tests. For example, if
an e x p e r i m e n t consisted of one con-
trol group (C), and three experimen-
tal groups (El, E2, E3), the compari-
sons m a d e using t-tests w o u l d be C
versus El, C versus E2, C versus E3,
E1 versus E2, E1 versus E3, and E2
versus E3. W h i l e this s e e m s logical
and certainly easy, it is i m p r o p e r and
can lead to serious errors in drawing
conclusions from the data.L4-6
W h e n several groups from an ex-
p e r i m e n t are compared using " m u l t i -
ple t-tests," the p r o b a b i l i t y of m a k -
ing a type I error (rejecting a true Ho)
is increased as the n u m b e r of com-
parisons made using independent
t-tests increases. 4 T h e increase in c~
level can be calculated as follows:
Step i
Number of comparisons:
X = no. of groups in experiment
C = no. of comparisons X(X - l)
2
Step 2
Corrected a level:
c~corrected = 1 - (1 - a) c
Example: As shown above, w i t h four
groups, there can be a m a x i m u m of
4(4 - 1)/2 = 6 paired comparisons. If
the original c~ level was P - .05, the
corrected o~ will be 1 (1 - .05) 6 =
.26. Thus, there is n o w a .26 chance
of i n a p p r o p r i a t e l y r e j e c t i n g the n u l l
h y p o t h e s i s (type I error) in at l e a s t
one of the six comparisons made. 4 In
m o s t s t u d i e s , t h i s w o u l d be u n a c -
ceptable! Should m u l t i p l e t - t e s t s be
m a d e a m o n g d e p e n d e n t groups, the
c o r r e c t e d c~ l e v e l s are e v e n g r e a t e r
t h a n t h o s e c a l c u l a t e d for i n d e p e n -
dent groups. 4 Thus, m u l t i p l e t - t e s t s
s h o u l d not be a c c e p t e d as a legiti-
m a t e m e a n s of data analysis for the
comparison of m o r e t h a n t w o
groups.4, 6
822/139
BIOSTATISTICS
Gaddis & Gaddis
ANALYSIS OF VARIANCE
Analysis of variance (ANOVA) has
long b e e n an a c c e p t e d m e t h o d of
comparing three or more groups from
one experiment. The advantages of
A N O V A over multiple t-tests include
the following: 6 1) The R level is held
c o n s t a n t at the preset level w i t h
ANOVA, while the ~ level for multi-
ple t-tests increases as the n u m b e r of
c o m p a r i s o n s i n c r e a s e s ; 4 2) o n e
A N O V A is less cumbersome to cal-
culate than are several t-tests; and 3)
A N O V A is a m o r e p o w e r f u l data
analysis m e t h o d than is the t-test.
A N O V A is the appropriate statistical
method to test for differences among
more than two groups. Often, it is as-
sumed that A N O V A is used to deter-
m i n e if there is a difference a m o n g
the m e a n s of t h e s e g r o u p s r a t h e r
t h a n a m o n g the groups' collective
values. This is an incorrect assump-
tion. W h i l e t h e m e a n describes a
group in a meaningful way, it is sim-
ply a descriptor of the group. Many
s t a t i s t i c a l r e f e r e n c e s will discuss
A N O V A as a c o m p a r i s o n b e t w e e n
means, but intragroup and intergroup
variability is what is actually being
analyzed.
It is also of value to u n d e r s t a n d
h o w A N O V A relates to the theory of
hypothesis testing. W i t h o u t the te-
d i u m of a guided tour t h r o u g h the
calculation of ANOVA, a simple ex-
planation of A N O V A follows.
A test of the null hypothesis can
be made in terms of two sets of dif-
ferences (subjects participate in only
o n e t r e a t m e n t , ie, s u b j e c t s are
"nested" within treatments). "One of
these sets of differences is obtained
by comparison of differences among
t r e a t m e n t groups, referred to as ex-
ternal or between-group differences.
The other set is obtained by compari-
son of differences among subjects re-
ceiving the same treatment within a
t r e a t m e n t group, termed internal or
within-group differences. Between-
group differences are a result of the
c o m b i n e d influence of the experi-
m e n t a l treatment plus experimental
error. W i t h i n - g r o u p differences are
t h e r e s u l t of e x p e r i m e n t a l e r r o r
alone. ''7 The comparison ratio:
Between-group differences
Within-group differences
is sensitive to the effects of experi-
mental treatment and can be written
as"
140/823
Treatment effect + experimental error
Experimental error
Assuming that the experimental er-
ror rate estimates are approximately
equal, a n y i n f l u e n c e of t r e a t m e n t
will result in a ratio that is greater
than 1. 7 The above example of hy-
pothesis testing illustrates the gen-
eral theory behind the mathematical
calculations of ANOVA.
Just as the t-test involves calcula-
tion of a t-statistic, w h i c h is com-
pared with a critical t, A N O V A in-
v o l v e s c a l c u l a t i o n of an F-ratio,
w h i c h is c o m p a r e d w i t h a critical
F-ratio. The F-ratio answers the ques-
tion, Is "the variability between the
groups large enough in comparison to
the variability of data within each
group to justify the conclusion that
two or more of the groups differ? ''6 If
the v a r i a b i l i t y b e t w e e n g r o u p s is
large enough, we can conclude that
there is a significant difference be-
tween groups. The F-r~}tio is defined
as follows:
F-ratio = Between-groups variance
Within-groups variance
A N O V A is not just one simply de-
fined computation. The experimental
design p o s s i b i l i t i e s are n u m e r o u s
with ANOVA. By using one test, sev-
eral factors (eg, drugs, dose levels,
dose times) can be analyzed for rela-
tionship at one time. The number of
F-ratios calculated in an ANOVA is
directly related to the n u m b e r of fac-
tors in t h e e x p e r i m e n t a l design.
Thus, each A N O V A computation is
u n i q u e to the e x p e r i m e n t a l design
being tested. It is the researcher's re-
sponsibility to ensure that the appro-
priate A N O V A is used, given the de-
sign of the study.
The a s s u m p t i o n s for A N O V A are
the same as those for the t-test. 4-6 To
reiterate: 1) T h e p o p u l a t i o n s f r o m
which the samples are drawn should
approach normal distribution; 2) the
variances of the p o p u l a t i o n s f r o m
which the samples were drawn
should be equal or nearly equal; and
3) the o b s e r v a t i o n s within groups
m u s t be independent.
These assumptions can usually be
met by random sampling and by use
of a good m e a s u r e m e n t scale. 6 The
more that the above assumptions for
ANOVA are violated, the more likely
a type I or type II error will be made. 6
As with the t-test, A N O V A is ro-
bust enough to be an appropriate test
Annals of Emergency Medicine
if the a b o v e a s s u m p t i o n s are n o t
strictly m e t (excepting the assump-
tion of independence, which m u s t be
met at all times).4, s When the com-
pared groups have equal values of n,
population variances need not be ho-
m o g e n o u s . Also, n o r m a l i t y of the
population distributions m a y be vio-
lated to a l i m i t e d degree w i t h o u t
c o n s e q u e n c e . 4-6 F i n a l l y , b e c a u s e
A N O V A is calculated using a param-
eter (variance), it is considered to be a
parametric statistical analysis
method and its use should be limited
to interval and ratio scale data.
Thus, there exist m a n y similarities
between the t-test and ANOVA. This
can further be extended to the calcu-
lated t from the t-test and to the F-ra-
tio from ANOVA. If an A N O V A was
being used instead of the t-test to
c o m p a r e t w o groups, it w o u l d be
found that F = t 2 for these data.4, 5
MULTIPLE COMPARISON
METHODS
Following a significant F test, the
next logical step w o u l d be to ask,
Which of the groups compared in the
A N O V A are significantly different?
This q u e s t i o n can be a n s w e r e d by
the use of multiple comparison pro-
cedures. "All are essentially based
upon the t-test but include appropri-
ate corrections for the fact that more
t h a n o n e c o m p a r i s o n is b e i n g
made."1
There exist n u m e r o u s legitimate
m e t h o d s of m u l t i p l e c o m p a r i s o n ,
each looking for unplanned yet "in-
teresting" differences in the experi-
m e n t a l data, but operating under a
different set of rules and a s s u m p -
tions. 5 The test that is selected for
use should be the test that meets the
needs of the researcher and the de-
sign of the study. But overall, it is
important to remember that the rea-
son for using A N O V A and a multiple
comparison method is ultimately to
control the experimentwise error rate
(the type I error rate for all compari-
sons) while at the same time making
several different comparisons.7 The
experimentwise error rate can be lim-
ited by reducing the n u m b e r of com-
parisons made or reducing the error
rate w i t h i n each c o m p a r i s o n . Be-
cause most researchers do not want
such imposing conditions placed on
their work, as would be the case by
limiting the n u m b e r of comparisons
allowed, the only other way to con-
trol the experimentwise error rate is
19:7 July 1990
to control the type I error rate w i t h i n
each comparison; hence, the purpose
behind multiple comparison tech-
niques. H o w e v e r , it is i m p o r t a n t to
n o t e t h a t in reducing the type I error
rate in such a way, there w i l l be an
i n c r e a s e i n t h e t y p e II e r r o r r a t e .
T h u s , b e f o r e p r o g r e s s i n g , t h e re-
s e a r c h e r m u s t d e t e r m i n e w h i c h is
m o r e d e t r i m e n t a l to the work, m a k -
ing t y p e I errors or m a k i n g type II
errors.7
A s u m m a r y flow chart of the selec-
tion of m u l t i p l e comparison tests is
s h o w n (Figure). Use of this figure w i l l
help guide t h e r e s e a r c h e r to select
the test m o s t appropriate for the ex-
p e r i m e n t a l design tested and research
questions asked. This flow chart, de-
veloped by H o p k i n s and Chadbourn 8
a n d m o d i f i e d b y K e p p e l , 7 w a s in-
tended to show the similarities and
differences b e t w e e n some of the var-
ious m u l t i p l e c o m p a r i s o n m e t h o d s .
It should n o t be used as a "fixed and
rigid plan for analysis. ''7 For the pur-
poses of this article, this chart serves
as a logical guide to aid the reader in
t h e u n d e r s t a n d i n g of m u l t i p l e com-
parison methods.
Before a n y m u l t i p l e c o m p a r i s o n
test, an c~ level is determined. Next,
an F test is performed. If a significant
F - r a t i o is o b t a i n e d , t h e p r o c e s s of
data analysis continues to d e t e r m i n e
w h i c h groups differ statistically. T h e
t e s t of Least Significant Difference
(LSD) is an o p t i o n if the r e s e a r c h e r
w i s h e s to c o n t r o l t h e c o m p a r i s o n -
wise error rate ( i n d i v i d u a l type I er-
ror rates for each comparison) ~ and if
a small n u m b e r of comparisons, rela-
tive to the total n u m b e r of compari-
sons possible, are to be made. How-
ever, if the e x p e r i m e n t w i s e error rate
(type I error rate for all comparisons)
must be held constant, other
m e t h o d s of m u l t i p l e c o m p a r i s o n
m u s t be considered.
T h e r e are two ways to control the
e x p e r i m e n t w i s e error rate, These in-
clude the layer or s t e p w i s e m e t h o d
and the e x p e r i m e n t w i s e method. T h e
layer method gradually adjusts the
type I error rate. T h e e x p e r i m e n t w i s e
m e t h o d h o l d s t h e t y p e I error rate
c o n s t a n t for a set of c o m p a r i s o n s .
T h e N e w m a n - K e u l s test and D u n c a n
test are examples of layer methods.
If an e x p e r i m e n t w i s e m e t h o d is se-
lected, the "type of comparisons to be
made will determine the multiple
comparison m e t h o d selected. If com-
p a r i s o n s are m a d e o n l y b e t w e e n a
19:7 July 1990
control group and experimental
groups, t h e D u n n e t t test is an option
of m u l t i p l e c o m p a r i s o n to consider.
However, if t h e group c o m p a r i s o n s
are b e t w e e n a n y groups, t h e r e are
other test options. The Dunn test
could be considered if there are only
a few c o m p a r i s o n s t o be m a d e . If
there are a large n u m b e r of compari-
sons to be made, the T u k e y test or
the Scheff4 test m i g h t be considered.
The Tukey test assumes that the
groups being c o m p a r e d are of equal
size and is appropriate in the simple
c o m p a r i s o n of one group w i t h an-
other. T h e Scheff4 t e s t is based on
t h e F s t a t i s t i c a n d t h u s is less af-
fected b y v i o l a t i o n s of the a s s u m p -
tions of n o r m a l i t y and h o m o g e n e i t y
of variances. Should comparisons be
desired b e t w e e n c o m p l e x c o m b i n a -
tions of groups, the Scheff4 test w i l l
be sensitive in detecting real differ-
ences. 7
While not included in the flow
chart, the Bonferroni t-test is a m u l t i -
ple c o m p a r i s o n m e t h o d f r e q u e n t l y
used in m e d i c a l literature. The Bon-
f e r r o n i t - t e s t a d j u s t s t h e p r e s e t c~
level by the n u m b e r of comparisons
to be made. t,9
O~adj = Cgp
where p is the preset ~ level and n is
t h e n u m b e r of c o m p a r i s o n s to b e
made. "If each c o m p a r i s o n is m a d e
using the critical t corresponding to
COp/n, t h e error rate for all c o m p a r i -
sons t a k e n as a group will be at m o s t
% . ' q T h u s the preset R level is pro-
tected. However, the Bonferroni
t-test b e c o m e s very c o n s e r v a t i v e as
the n u m b e r of comparisons m a d e in-
creases. 1
Finally, as previously noted, confi-
dence intervals m a y be m o r e useful
t h a n m u l t i p l e c o m p a r i s o n t e s t s in
analysis of intergroup similarity.2,3, 9
" C o n f i d e n c e i n t e r v a l s : 1) Show t h e
degree of u n c e r t a i n t y in each c o m -
p a r i s o n i n an e a s i l y i n t e r p r e t a b l e
way; 2) m a k e it easier to assess t h e
practical significance of a difference
as well as the statistical significance;
and 3) are less l i k e l y to lead non-stat-
i s t i c i a n s to t h e i n v a l i d c o n c l u s i o n
t h a t n o n s i g n i f i c a n t l y different sam-
ple m e a n s i m p l y e q u a l p o p u l a t i o n
means.'9
T h e above d i s c u s s i o n of m u l t i p l e
c o m p a r i s o n m e t h o d s and t h e i r uses
is a basic overview of just a few of
the possible options available to the
Annals of Emergency Medicine
researcher. There are other l e g i t i m a t e
m e t h o d s that have n o t been i n c l u d e d
in this d i s c u s s i o n b e c a u s e of space
limitations. Furthermore, statistical
procedures and opinions on m u l t i p l e
c o m p a r i s o n t h e o r y are c o n t i n u a l l y
evolving. The researcher is free to se-
lect whatever multiple comparison
m e t h o d is d e s i r e d as l o n g as t h e
m e t h o d is appropriate for the experi-
m e n t a l design and research questions
asked.
SUMMARY
In conclusion, w h e n selecting t h e
m e t h o d for h y p o t h e s i s testing, s i m -
plicity and familiarity must be
p u s h e d aside for a s s u r a n c e t h a t t h e
data being analyzed m e e t t h e defined
a s s u m p t i o n s r e q u i r e d for use of a
given test. For the t-test and
ANOVA, these a s s u m p t i o n s i n c l u d e
n o r m a l i t y of t h e p o p u l a t i o n s f r o m
w h i c h the d a t a come, h o m o g e n e i t y
of the variances of the sample popu-
lations, and independence of the data
points w i t h i n a sample group.
If t h e e x p e r i m e n t a l design consists
of only two groups, the t-test is ap-
propriate to test for a significant dif-
ference b e t w e e n these groups. How-
ever, if there are three or m o r e groups
to compare, the t-test is inappropri-
ate because the preset level will in-
crease w i t h the n u m b e r of compari-
sons made.
A N O V A is a p o w e r f u l s t a t i s t i c a l
test to d e t e r m i n e s i m u l t a n e o u s l y if
t h e r e is a s i g n i f i c a n t d i f f e r e n c e
a m o n g three or m o r e groups. W h i l e
t h e F - r a t i o w i l l t e l l if s i g n i f i c a n c e
a m o n g any of the groups exists, it
gives no information regarding w h i c h
of the groups differs.
T h u s , f o l l o w i n g a s i g n i f i c a n t F-
ratio, a m u l t i p l e c o m p a r i s o n test can
be selected t h a t will define w h i c h of
the three or m o r e groups is differenL
T h e m u l t i p l e comparison m e t h o d se-
lection is based on the e x p e r i m e n t a l
d e s i g n and t h e r e s e a r c h q u e s t i o n s
asked.
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19:7 July 1990