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Preprint . 2025
License: CC BY
Data sources: ZENODO
https://doi.org/10.2139/ssrn.5...
Article . 2025 . Peer-reviewed
Data sources: Crossref
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Preprint . 2025
License: CC BY
Data sources: Datacite
ZENODO
Preprint . 2025
License: CC BY
Data sources: Datacite
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Fragility of the Fragility Index: When Calculation Becomes Impossible

Authors: Heston, Thomas F;

Fragility of the Fragility Index: When Calculation Becomes Impossible

Abstract

The Fragility Index (FI) has become a widely cited measure of statistical robustness in clinical trials, yet its computation often fails under Fisher’s exact test constraints. This paper systematically demonstrates that the FI is mathematically unattainable across a broad range of realistic clinical scenarios—including rare events, balanced small samples, and extreme imbalances—using 14 representative 2×2 contingency tables. Alternative fragility metrics, including the Percent Fragility Index (PFI), Relative Risk Index (RRI), Risk Quotient (RQ), and Robustness Index (RI), were evaluated for computational success and interpretability. The FI failed in 100% of test cases, while PFI and RQ achieved universal computability (100%) and provided clinically meaningful interpretations. The RQ, in particular, quantifies distance from therapeutic neutrality on a bounded 0–1 scale and avoids dependence on statistical significance thresholds. These findings reveal that the FI itself is fragile, supporting a transition toward universally computable and clinically interpretable fragility metrics such as PFI and RQ.

Related Organizations
Keywords

Clinical Trials as Topic, clinical trials, evidence assessment, Risk Quotient, Percent Fragility Index, Fisher's exact test, Methodology, fragility index, methodology, statistical robustness

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
1
Average
Average
Average
Green