Improvements in the application and reporting of advanced Bland–Altman methods of comparison

• Published in: Journal of clinical monitoring and computing Vol. 29; no. 1; pp. 127 - 139
• Main Authors: Olofsen, Erik, Dahan, Albert, Borsboom, Gerard, Drummond, Gordon
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.02.2015; Springer Nature B.V
• Subjects: Algorithms; Anesthesiology; Biometry - methods; Computer programs; Computer Simulation; Confidence Intervals; Critical Care Medicine; Format; Health Sciences; Humans; Intensive; Limit of Detection; Medicine; Medicine & Public Health; Models, Statistical; Models, Theoretical; Monitoring; Monte Carlo Method; Original Research; Programming Languages; Reporting; Reproducibility of Results; Software; Statistics for Life Sciences; Confidence intervals; Software; Bland–Altman; Limits of agreement
• ISSN: 1387-1307; 1573-2614; 1573-2614
• DOI: 10.1007/s10877-014-9577-3

Bland and Altman have developed a measure called “limits of agreement” to assess correspondence of two methods of clinical measurement. In many circumstances, comparisons are made using several paired measurements in each individual subject. If such measurements are considered as statistically independent pairs, rather than as sets of measurements from separate individuals, limits of agreement will be too narrow. In addition, the confidence intervals for these limits will also be too narrow. Suitable software to compute valid limits of agreement and their confidence intervals is not readily available. Therefore, we set out to provide a freely available implementation accompanied by a formal description of the more advanced Bland–Altman comparison methods. We validate the implementation using simulated data, and demonstrate the effects caused by failing to take the presence of multiple paired measurements per individual properly into account. We propose a standard format of reporting that would improve analysis and interpretation of comparison studies.