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Exploracion basada en la evidencia
 

Exploracion basada en la evidencia

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    Exploracion basada en la evidencia Exploracion basada en la evidencia Presentation Transcript

    • EXPLORACION BASADA EN LA EVIDENCIA
    • LR + (LIKELIHOOD RATIO DEL VALOR POSITIVO)
      LR + = [VP/ (VP + FN)] / [FP/ (FP+VN)]
      LR + = SENSIBILIDAD / (1- ESPECIFICIDAD)
    • LR - = LIKELIHOOD NEGATIVO
      LR - = [FN / (VP + FN)] / [ VN / (FP + VN)]
      LR - = ( 1 – SENSIBILIDAD) / ESPECIFICIDAD
    • LR: Impact on Likelihood of Disease
      LR = 0.01
      Less
      Likely
      LR = 100
      More
      Likely
      LR = 0.1
      Less
      Likely
      LR = 10
      More
      Likely
      LR = 0.2
      Less
      Likely
      LR = 5
      More
      Likely
      LR = 0.3
      Less
      Likely
      LR = 3
      More
      Likely

      0
      increasing impact
      Increasing impact
      LR = 1
      No
      Impact on Likelihood of Disease
    • Does This Adult Patient Have Acute Meningitis?
    • Case Scenario 1
      30-year-old man presents to emergency department (ED)
      24-hour history of chills and a stiff neck
      Afebrile with normal mental status
      Full neck flexion but with cervical pain
      Kernig and Brudzinski signs absent
    • LR: Impact on Likelihood of Disease
      LR = 0.01
      Less
      Likely
      LR = 100
      More
      Likely
      LR = 0.1
      Less
      Likely
      LR = 10
      More
      Likely
      LR = 0.2
      Less
      Likely
      LR = 5
      More
      Likely
      LR = 0.3
      Less
      Likely
      LR = 3
      More
      Likely

      0
      increasing impact
      Increasing impact
      LR = 1
      No
      Impact on Likelihood of Disease
    • Test Characteristics: Examination
      Likelihood Ratios From Prospective Studies
    • Likelihood Ratio
      Jolt accentuation test
      LR– = 0.05
      If negative, posttest probability < 0.1%
      Jolt accentuation test
      LR+ = 2.4
      1% Pretest probability in population presenting to ED
      If positive, posttest probability = 2%
    • Caso I
      Paciente de 33 años, mujer,
      Cefalea holocraneal
      Características del dolor: no bien definido
      Fotofobia
      Fonofobia
      Náuseas
      Empeora con el esfuerzo físico
    • Caso II
      Paciente mujer de 42 años, que mientras practica carrera de fondo siente dolor súbito frontoparietal muy intenso desde el inicio.
      No refiere antecedentes personales ni familiares de interés.
      Consciente en todo momento con sensación de dolor grave.
    • Caso III
      Cefalea crónica diaria
      Mujer de 52 años
      Abuso de analgésicos
      Debuta con diplopid y afasia.
    • NO OLVIDEN LIKELIHOOD RATIO