PERMUTATION TESTS AND OTHER TEST STATISTICS FOR ILL-BEHAVED DATA: EXPERIENCE OF THE NINDS t-PA STROKE TRIAL
Permutation tests are often used to analyze data since they may not require one to make assumptions regarding the form of the distribution to have a random and independent sample selection. We initially considered a permutation test to assess the treatment effect on computed tomography lesion volume in the National Institute of Neurological Disorders and Stroke (NINDS) t-PA Stroke Trial, which has highly skewed data. However, we encountered difficulties in summarizing the permutation test results on the lesion volume. In this paper, we discuss some aspects of permutation tests and illustrate our findings. This experience with the NINDS t-PA Stroke Trial data emphasizes that permutation tests are useful for clinical trials and can be used to validate assumptions of an observed test statistic. The permutation test places fewer restrictions on the underlying distribution but is not always distribution-free or an exact test, especially for ill-behaved data. Quasi-likelihood estimation using the generalized estimating equation (GEE) approach on transformed data seems to be a good choice for analyzing CT lesion data, based on both its corresponding permutation test and its clinical interpretation.