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Pediatrics published an RCT of TIPP, a program to help pediatricians prevent injuries in children 0-2. Quick take: The main study finding - reduced child injuries - isn't reliable because this was a cluster RCT (4 sites were randomized) & the analysis didn't adjust for clustering.

  • The study randomly assigned 4 academic medical centers, containing a total sample of 865 infant-parent dyads, to TIPP vs control. TIPP, designed by the American Academy of Pediatrics, helps pediatricians identify parental at-risk behavior & counsel/support parents in injury prevention.


  • The study's randomization of just 4 medical centers is nowhere near large enough to produce highly-similar treatment & control groups - the essential condition for a valid RCT - because the 4 centers differ systematically in their patient populations, as shown here:  



  • Given such cross-site differences, the study can't rule out the possibility that the difference in injury outcomes between treatment sites (Miami, UNC) & control sites (NYU, Vanderbilt) is due to underlying differences in their patients &/or physicians, rather than the TIPP program.


  • The only reason the study was able to "find" statistically significant effects on injuries is that its analysis inappropriately ignored the clustering of patients within the 4 centers.

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