Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: We agree with Dr Radzik and colleagues that the limited number of pediatric studies warrants some caution in applying our study's results. As they note, a large randomized trial would be necessary to detect a statistically significant increase in management errors, but this is largely a function of the low baseline rates of such errors. In the trial cited by Radzik et al,1 the sample size required to detect a difference of 1 delayed diagnosis of appendicitis was calculated based on a baseline rate of only 1%. The investigators in that trial found 1 management error out of 108 patients; thus, their sample-size calculation assumes a target of zero management errors.
Ranji SR, Goldman LE, Simel DL, Shojania KG. Opiates and Acute Abdominal Pain—Reply. JAMA. 2007;297(5):467–468. doi:10.1001/jama.297.5.468-a
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