ebcr group 1b with ca
TRANSCRIPT
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Evidence Based Case ReportPeripheral Arterial Disease
Kelompok I-B
Rena Winanti
Stella Margaretha
Youdiil Ophinni
Karina Faisha
Seprializa
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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?
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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?
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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
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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
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CRITICAL APPRAISAL
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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
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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%.
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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
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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
LEFT LEGMagnetic Resonance
Angiography Total
Stenosis 50% Stenosis < 50%
Ankle-BrachialIndex
< 0,9 9 2 11
0,9 52 202 254
Total 61 204 265
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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
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NOTES
Blinding?
LR+ 20 & 15 kenapa?
ABI memiliki spesivisitas dan tinggi dansensitivitas yang rendah, apakah lebih baik
dari MR angiografi?
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