CRITICAL APPRAISAL

on Diagnostic
CITATION :
Asking the clinical question

PICO
How estimate the diagnostic accuracy of chest
radiography in the detection of chest
lymphadenopathy in children with clinically
suspected pulmonary-TB ?
 CRITICAL APPRAISAL

1. Are the result of the study valid?

2. What were the result?
3. Will the results help me in caring for
my patient?
DIAGNOSIS WORKSHEET

CITATION :
ABSTRACT

DIAGNOSTIC
TEST
 Are the result of the study valid?

Was there an independent, blind comparison

with a reference standard of diagnosis ?

Did the patient sample include an

appropriate spectrum of patients to whom the
diagnostic test will be applied in clinical
practice?
 Are the result of the study valid?

A Independent
Blind
Reference standard
Diagnostic test comparison
(gold standard)

Abstract
Independent & Blind ? METHODS

INDEPENDENT
BLIND
Are the result of the study valid?

Was the reference standard applied regardless

of the diagnostic test result ?

result (-) Gold standard

result (+) Gold standard

 Are the result of the study valid?

Was there an independent, blind comparison

with a reference standard of diagnosis ?

YES, .
On page was described
Are the result of the study valid?

B All spectrum of patients from mild to severe

 Are the result of the study valid?

Did the patient sample include an

appropriate spectrum of patients to whom the
diagnostic test will be applied in clinical
practice?

YES,
Are the result of the study valid?

Did the result of the test being evaluated

influence the decision to perform the reference
standard?
Related to independently of study method

Was the test (or cluster of test) validated in a

second, independent group of patients?

METHOD, DISCUSSION ?
Details of
methods

Details of
methods

What were the result?

Are likelihood ratios for the test results

presented or data necessary for their
calculation provided?
Result?
 CRITICAL APPRAISAL ON DIAGNOSTIC

What were the result?

Gold standard (Spiral chest CT w contrast inj)

(+) (-)

Diagnostic (+) a b N1
Test
(Chest X-Rays) (-) c d N2

N3 N4 N
 CRITICAL APPRAISAL ON DIAGNOSTIC

What were the result?

Sensitivity = a/(a+c) x 100%
Specifisity = d/(b+d) x 100%
LR+ = sensitivity/(1-specifisity)
LR- = (1-sensitivity)/specifisity
Pretest probability: (a+c)/(a+b+c+d) (prevalence)
Pretest odds: prevalence/1-prevalence
Post-test odds: pre-test odds x LR
Post-test probability: post-test odds/post-test odds+1
Result?
How to apply ?
If we meet a patient think of pre-
test probability of certain disease
If we continue to conduct the
diagnostic test should determine
the benefit more than harm

If there is a significance change between

both the test is going to be benefit for
further clinical decision
Nomogram
Likelihood ratio
>10 or < 0,1 give the big change of
pre to post test probability usually
conclusive
5-10 or 0.1-0.2, intermediate changes
2-5 or 0,5-0,2, small changes
(occasionally important)
1-2 or 0,5-1, very small change of
probability (mostly never important)
Test-treatment tresholds

Do not Do not
test
Test, & treat on test
the basis of the
tests results
Do not Get on with
treat treatment

0 .10 .20 .30 .40 .50 .60 .70 .80 .90

A B
Prevalence (pre-test probability) of target disoreder
TERIMA KASIH