ebcr group 1b with ca

8/13/2019 Ebcr Group 1b With CA

1/15

Evidence Based Case ReportPeripheral Arterial Disease

Kelompok I-B

Rena Winanti

Stella Margaretha

Youdiil Ophinni

Karina Faisha

Seprializa


2/15

Clinical Question

Pada pasien usia tua dengan klaudikasio

intermiten, seberapa akuratkah pemeriksaan

ankle-brachial index untuk mendiagnosis

penyakit arteri perifer apabila dibandingkan

dengan MR angiografi?


3/15

Pada

pasien usia

tua dengan

klaudikasio

intermiten

Clinical Question: PICO

P I C O

..seberapa

akuratkah

pemeriksaa

n ABI

..dibandingka

n dengan MR

angiografi

..untuk

mendiagnos

is PAD?


4/15

Search Strategy

Database Search strategy Hits Selected articles

Pubmed "ankle brachial index" and "magnetic

resonance" and (peripheral arterial

disease OR peripheral arterial

occlusive disease) AND elderly

23 1

Cochrane Ankle brachial index AND Magnetic

Resonance AND Peripheral arterial

disease

6 0

Medline ankle brachial index AND peripheral

AND arterial AND (occlusive OR

disease) AND magnetic resonance

angiography AND elderly ANDspecificity AND sensitivity OR

predictive

383 1


5/15

PubMed

Magnetic

Resonance

Angiograph

y

Screening title abstract*

Filtering doubles

23

12

Exclusion criteria:-Journal published before

2005

-Animals

-Language other than

English/Indonesian

Ankle

Brachial

IndexElderly

A

N

D

A

N

D

Useful:

1 article

2

Full text available

93

Search date: 2 June 2010

*All decisions were made by consensus or at

least 2 authors

Inclusion criteria:

-Relevant to our

clinical question

-Diagnostic study

-Age > 45 years

Medline

383

116

Cochrane

6

3

Inclusion criteria:

- Published in the last 5

years

-Humans

-English/Indonesian

Exclusion criteria:

-Irrelevant to our

clinical question

-Study other than

diagnostic study

-Age < 45 years

1


6/15


7/15

CRITICAL APPRAISAL


8/15

Validity of study

Was there an independent,blind comparison with

reference (gold) standard

diagnosis?

YES??blinding?

Was the diagnostic testevaluated in appropriate

spectrum of patients (like

those in whom it would be

used in practise)

Yes, Elderly w/ clinicalcharacter prevalence of

atherosclerosis change

Was the reference standard

applied regardless of the

diagnostic test result?

Yes


9/15

Importance

The results of the study (ABI and MRAexaminations) were differentiated betweenfindings in right leg (n = 268) and left leg (n =

265). Findings for ABI as the diagnostic test were

regarded as positive if ABI < 0,9 and negative ifABI 0,9.

Findings for MRA as the gold standard werepositive if arterial stenosis 50% and negative if

stenosis < 50%.


10/15

RIGHT LEGMagnetic Resonance

Angiography Total

Stenosis 50% Stenosis < 50%

Ankle-Brachial

Index

< 0,9 10 2 12

0,9 41 215 256

Total 51 217 268

Sn = 10/51 = 20 %

Sp = 215/217 = 99%

PPV = 10/12 = 83%

NPV = 215/256 = 84%

LR+ = 20%/1% = 20

LR- = 80%/99 %= 0.8

Pre-test probability = 51/268 = 19%

Pre-test odds = 19%/82% = 0,24

Post-test odds = 0.24 x 20 = 4.7

Post-test probability = 4.7/5.7 = 0.82


11/15


12/15

RIGHT LEGMagnetic Resonance

Angiography Total


Ankle-Brachial

Index

< 0,9 10 2 12

0,9 41 215 256

Total 51 217 268

LEFT LEGMagnetic Resonance

Angiography Total


Ankle-BrachialIndex

< 0,9 9 2 11

0,9 52 202 254

Total 61 204 265


13/15

Apply this validityIs the diagnostic test

available, affordable,accurate, and precise in your

setting?

YES

Can you generate a clinically

sensible estimate of your

patients pre-test probabilitiy?

Yes

Will the resulting post-test

probabilities affect your

management and help your

patient?

Yes

Would the consequences of

the test help your patient?

Yes


14/15

NOTES

Blinding?

LR+ 20 & 15 kenapa?

ABI memiliki spesivisitas dan tinggi dansensitivitas yang rendah, apakah lebih baik

dari MR angiografi?


15/15

ebcr group 1b with ca

Documents