Critical Appraisal EBM Diagnosis

DK B-4 Semester IV Fasilitator : dr. M. Ali, Sp.A

Kutipan (Citation) :
The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block

Validity
Was there an independent, blind, comparison with a reference (gold) standard of diagnosis?

YES YES YES CANNOT TELL

Was the diagnostic test evaluated in an appropriate spectrum of patients (like those in whom it would be used in practice)?
Was the reference standard applied regardless of the diagnostic test result? Was the test (or cluster of test) validated in a second, independent group of patient?

Importance
INVASIVE CORONARY ANGIOGRAPHY Normal or Stenosis < 50% TOTALS Stenosis > 50% MSCT-A 104 18 122

Stenosis > 50%

Normal or Stenosis < 50%

52

619

671

TOTALS

156

637

793

 Sensitivity = 104/156 x 100% = 67% Specificity = 619/637 x 100% = 97% Likelihood ratio for positive test result = 0,67/(1-0,97) = 22,33 Likelihood ratio for negative test result = (1-0,67)/0,97 = 0,34 Positive predict value = 104/122 x 100% = 85,2% (85%) Negative predict value = 619/6671 x 100% = 92,2% (92%) Pretest probability (prevalence) = 156/793 x 100% = 19,82% (20%) Pre test odds = 0,2/(1-0,2) = 0,25 Post test odds = 0,25 x 22,33 = 5,6 Post test probability = 5,6/(5,6+1) x 100% = 84,8% (85%)

Applicability
Is the diagnostic test available, affordable, accurate, and precise in your setting? Can you generate a clinically sensible estimate of your patients pre-test probability (from personal experience, prevalence statistics, practice database, or primary studies)? Are the study patients similar to your own? Is it unlikely that the disease possibilities or probabilities have changed since the evidence was gathered? Will the resulting post-test probabilities affect your management and help your patient? Could it move you across a test-treatment threshold? Would your patient be a willing partner in carrying it out? Would the consequences of the test help your patient?

NO

YES

YES YES