Evidence Based Medicine

(DIAGNOSTICS)
 GENERAL OBJECTIVES
• To present a literature for an Evidence Base
Medicine approach to Diagnostic testing.
 SPECIFIC OBJECTIVE
• To present a case to which an EBM Diagnostic
testing is applied
• To formulate a diagnostic question
• To present a literature on how to appraise the
validity of an evidence based diagnostics in
detecting Mycobacterium tuberculosis
• To compute for Sensitivity, Specificity, Positive
Predictive Value (PPV), Negative Predictive
Value (NPV), Likelihood Ratio for Positive and
Negative results
• To answer the diagnostic question and
interpret the results
 STEPS IN EBM
1. ASK
- Identifying a problem or area of uncertainty
- Formulating a relevant, focused, clinically
important question that is likely to be
answered
2. ACQUIRE
- Finding and appraising the evidence
3. Assessing the clinical importance of the
evidence
4. APPLY
- Assessing the clinical applicability of any
recommendation or conclusions
- Deciding whether or not to act on the
evidence
5. ASSESS
- Assessing the outcomes of the physician’s
actions
- Summarizing and storing records for future
reference
ASK?
 CLINICAL SCENARIO
• A 55 year old female came in for consultation,
patient was apparently well until patient
noted fever (tmax 38.6˚C) and painful
urination . Sought consult at the E.R. fatima.
Doctor Kwek Kwek initially diagnosed her with
Urinary Tract Infection and advised for
Dipstick Urinalysis. The Doctor wants to know
the sensitivity between the nitirites and
Leucocyte Esterase as a screening test for UTI.
 FORMULATING QUESTIONS THAT IS
LIKELY TO BE ANSWERED (PICOM)
POPULATION: A 55 year old female
INTERVENTION: Leukocyte Esterase
COMPARISON: Nitrites
OUTCOME: Sensitivity in Urinary Tract Infection
METHOD: Prospective Cross Sectional Study
 IDENTIFICATION OF A PROBLEM OR
AREA OF UNCERTAINTY
Between Leukocyte Esterase and Nitrites which
among them is most sensitive as a screening
test in diagnosing Urinary Tract Infection?
ACQUIRE?
FINDING AND APPRAISING THE
EVIDENCE
FINDING AND APPRAISING THE
EVIDENCE
FINDING AND APPRAISING THE
EVIDENCE
APPRAISE?
Was the diagnostic test evaluated in a representative spectrum of YES NO UNCLEAR/
patients (like those in whom it would be used in practice COMMENT
What is BEST ? Where do I find the information?

Its is deal if test

 OVERVIEW OF THE JOURNAL
BACKGROUND:
Acute appendicitis continues to be a challenging
diagnosis. Preoperative radiological imaging
using ultrasound (US) or computed
tomography (CT) has gained popularity as it
may offer a more accurate diagnosis than
classic clinical evaluation.
• The optimal implementation of these
diagnostic modalities has yet to be
established. The aim of the present study was
to investigate a diagnostic pathway that uses
routine US, limited CT, and clinical re-
evaluation for patients with acute
appendicitis.
MATERIALS AND METHODS
METHODS:
A prospective analysis was performed of all
patients presenting with acute abdominal pain
at the emergency department from June 2005
until July 2006 using a structured diagnosis
and management flowchart. Daily practice
was mimicked, while ensuring a valid
assessment of clinical and radiological
diagnostic accuracies and the effect they had
on patient management.
 Ultrasound
• Ultrasound is safe, easily accessible, and, most
important, does not use ionizing radiation