TELAAH UJI DIAGNOSTIK

Prodi Ilmu Bedah Plastik

Judul Artikel:
Challenges in diagnosing tuberculosis in children: a
comparative study from Sudan

Penulis:
Mogahid M. Elhassan, Miskelyemen A. Elmekki, Ahmed L.
Osman, Mohamed E. Hamid

Jurnal:
International Journal of Infectious Diseases
APAKAH UJI DIAGNOSTIK INI VALID?

Apakah pemeriksaan uji dan baku emas

dilakukan secara tersamar?
YA
Baku emas: kultur Lowenstein Jensen
Perbandingan: Tuberculin Skin Test, Ziehl-Neelsen and Auramine fluoresence stains,
PCR amplification and gel electrophoresis

Apakah uji diagnostik ini mencakup spektrum

yang sesuai seperti dalam praktik?
YA
Pemeriksaan dilakukan pada anak-anak yang dicurigai TB dari 5 senter TB

Apakah baku emas tetap diperiksa tanpa melihat

hasil uji diagnostik?
YA
Pada pemeriksaan ini dilakukan pemeriksaan kultur Lowenstein Jensen
APAKAH UJI DIAGNOSTIK INI PENTING?
Baku emas (Lowenstein Jensen) Total

Ada Tidak
Hasil Uji Positif 32 54 86
(TST) A B a+b
Negatif 0 111 111
C D c+d
Total 32 165 197
a+c b+d a+b+c+d
Sensitivity = a/(a+c) = 32/32= 100%
Specificity = d/(b+d) = 111/165 = 67.3%
Likelihood ratio for a positive test result = LR+ = sens/(1-spec) = 100%/32.7% = 3.06
Likelihood ratio for a negative test result = LR - = (1-sens)/spec = 0%/67.3% = 0
Positive Predictive Value = a/(a+b) = 32/86 = 37.2%
Negative Predictive Value = d/(c+d) = 111/111 = 100%
Pre-test probability (prevalence) = (a+c)/(a+b+c+d) = 32/197 = 16.2%
Pre-test odds = prevalence/(1-prevalence) = 16.2%/83.8% = 0.19
Post-test odds = pre-test odds  LR = 0.58 (positif) 0 (negatif)
Post-test probability = post-test odds/(post-test odds +1) = 0.37 (positif) 1 (negatif)
APAKAH UJI DIAGNOSTIK INI PENTING?
Baku emas (Lowenstein Jensen) Total

Ada Tidak
Hasil Uji Positif 14 2 16
(ZN) A B a+b
Negatif 18 163 181
C D c+d
Total 32 165 197
a+c b+d a+b+c+d
Sensitivity = a/(a+c) = 14/32= 43.8%
Specificity = d/(b+d) = 163/165 = 98.8%
Likelihood ratio for a positive test result = LR+ = sens/(1-spec) = 43.8%/1.2% = 36.5
Likelihood ratio for a negative test result = LR - = (1-sens)/spec = 56.2%/98.8%=0.57
Positive Predictive Value = a/(a+b) = 14/16 = 87.5%
Negative Predictive Value = d/(c+d) = 163/181 = 90%
Pre-test probability (prevalence) = (a+c)/(a+b+c+d) = 32/197 = 16.2%
Pre-test odds = prevalence/(1-prevalence) = 16.2%/83.8% = 0.19
Post-test odds = pre-test odds  LR = 6.94 (positif) 0.11 (negatif)
Post-test probability = post-test odds/(post-test odds +1) = 0.874 (positif) 0.1 (negatif)
APAKAH UJI DIAGNOSTIK INI PENTING?
Baku emas (Lowenstein Jensen) Total

Ada Tidak
Hasil Uji Positif 18 3 21
(auramine) A B a+b
Negatif 14 162 176
C D c+d
Total 32 165 197
a+c b+d a+b+c+d
Sensitivity = a/(a+c) = 18/32= 56.3%
Specificity = d/(b+d) = 162/165 = 98.2%
Likelihood ratio for a positive test result = LR+ = sens/(1-spec) = 56.3%/1.8% = 31.3
Likelihood ratio for a negative test result = LR - = (1-sens)/spec = 43.7%/98.2%=0.45
Positive Predictive Value = a/(a+b) = 18/21 = 85.7%
Negative Predictive Value = d/(c+d) = 162/176 = 92.0%
Pre-test probability (prevalence) = (a+c)/(a+b+c+d) = 32/197 = 16.2%
Pre-test odds = prevalence/(1-prevalence) = 16.2%/83.8% = 0.19
Post-test odds = pre-test odds  LR = 5.94 (positif) 0.086 (negatif)
Post-test probability = post-test odds/(post-test odds +1) = 0.86 (positif) 0.08 (negatif)
APAKAH UJI DIAGNOSTIK INI PENTING?
Baku emas (Lowenstein Jensen) Total

Ada Tidak
Hasil Uji Positif 32 3 35
(PCR) A B a+b
Negatif 0 162 162
C D c+d
Totals 32 165 197
a+c b+d a+b+c+d
Sensitivity = a/(a+c) = 32/32= 100%
Specificity = d/(b+d) = 162/165 = 98.2%
Likelihood ratio for a positive test result = LR+ = sens/(1-spec) = 100%/1.8% = 55.6
Likelihood ratio for a negative test result = LR - = (1-sens)/spec = 0%/98.2%=0
Positive Predictive Value = a/(a+b) = 32/35 = 92%
Negative Predictive Value = d/(c+d) = 162/162 = 100%
Pre-test probability (prevalence) = (a+c)/(a+b+c+d) = 32/197 = 16.2%
Pre-test odds = prevalence/(1-prevalence) = 16.2%/83.8% = 0.19
Post-test odds = pre-test odds  LR = 10.56 (positif) 0 (negatif)
Post-test probability = post-test odds/(post-test odds +1) = 0.92 (positif) 0 (negatif)
APPLICABILITY : DAPATKAH KITA MENERAPKAN HASIL STUDI
INI PADA PASIEN KITA?

Apakah pasien kita mirip dengan pasien pada studi diagnostik ini?
YA
Apakah kita dapat memperkirakan prevalens (Pre Test Probability) pasien
kita? (Berdasar pengalaman, pustaka, dst) YA
Apakah hasil uji diagnostik ini, khususnya nilai prediksi positif (NPF)-nya
membantu tata laksana terhadap pasien kita? YA
Apakah secara keseluruhan uji ini membantu pasien kita?
YA
THANK YOU