Correspondence  |   March 2017
In Reply
Author Notes
  • Division of Anesthesiology, University Hospital of Zurich, Zurich, Switzerland (F.H.).
  • (Accepted for publication October 20, 2016.)
    (Accepted for publication October 20, 2016.)×
Article Information
Correspondence   |   March 2017
In Reply
Anesthesiology 3 2017, Vol.126, 570-573. doi:10.1097/ALN.0000000000001451
Anesthesiology 3 2017, Vol.126, 570-573. doi:10.1097/ALN.0000000000001451
We would like to thank Drs. Warner, Qiu, and colleagues for their valuable inputs regarding our systematic review.1 
Dr. Warner rightly points out that CIs crossing the equality line correspond to nonsignificant results and suggests that the wording of our findings may have failed to reflect this lack of statistical significance. Although we agree that “borderline” results (i.e., where one end of the CI just overlaps the null value) should be interpreted with caution, it is worth to note that the Cochrane Collaboration discourages formulations such as “nonsignificant” or “not statistically significant,” since these terms are commonly misinterpreted as an indication that “the intervention has no effect.”2  Although some authors would describe such findings as a “tendency” or a “trend” toward an effect, we opted for a more moderate wording (i.e., using formulations such as “seemed to” or “possible increase”), as suggested elsewhere.3  As for the interpretation of borderline findings, it might help to remember that the true effect is more likely to lie around the point estimate (i.e., around the risk ratio) than at the margins of the CI.3  The traditionally significant P < 0.05 may well be suitable for testing efficacy, but CIs rather than hypothesis testing are preferred when testing safety, equivalence, or noninferiority.4 
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