Exploracion basada en la evidencia

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Exploracion basada en la evidencia

  1. 1. EXPLORACION BASADA EN LA EVIDENCIA<br />
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  14. 14. LR + (LIKELIHOOD RATIO DEL VALOR POSITIVO)<br />LR + = [VP/ (VP + FN)] / [FP/ (FP+VN)]<br />LR + = SENSIBILIDAD / (1- ESPECIFICIDAD)<br />
  15. 15. LR - = LIKELIHOOD NEGATIVO<br />LR - = [FN / (VP + FN)] / [ VN / (FP + VN)]<br />LR - = ( 1 – SENSIBILIDAD) / ESPECIFICIDAD<br />
  16. 16. LR: Impact on Likelihood of Disease<br />LR = 0.01<br />Less<br />Likely<br />LR = 100<br />More<br />Likely<br />LR = 0.1<br />Less<br />Likely<br />LR = 10<br />More<br />Likely<br />LR = 0.2<br />Less<br />Likely<br />LR = 5<br />More<br />Likely<br />LR = 0.3<br />Less<br />Likely<br />LR = 3<br />More<br />Likely<br /><br />0<br />increasing impact<br />Increasing impact<br />LR = 1<br />No <br />Impact on Likelihood of Disease<br />
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  19. 19. Does This Adult Patient Have Acute Meningitis?<br />
  20. 20. Case Scenario 1<br />30-year-old man presents to emergency department (ED)<br />24-hour history of chills and a stiff neck<br />Afebrile with normal mental status<br />Full neck flexion but with cervical pain<br />Kernig and Brudzinski signs absent <br />
  21. 21. LR: Impact on Likelihood of Disease<br />LR = 0.01<br />Less<br />Likely<br />LR = 100<br />More<br />Likely<br />LR = 0.1<br />Less<br />Likely<br />LR = 10<br />More<br />Likely<br />LR = 0.2<br />Less<br />Likely<br />LR = 5<br />More<br />Likely<br />LR = 0.3<br />Less<br />Likely<br />LR = 3<br />More<br />Likely<br /><br />0<br />increasing impact<br />Increasing impact<br />LR = 1<br />No <br />Impact on Likelihood of Disease<br />
  22. 22. Test Characteristics: Examination<br />Likelihood Ratios From Prospective Studies<br />
  23. 23. Likelihood Ratio<br />Jolt accentuation test <br />LR– = 0.05<br />If negative, posttest probability < 0.1% <br />Jolt accentuation test <br />LR+ = 2.4<br />1% Pretest probability in population presenting to ED<br />If positive, posttest probability = 2%<br />
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  41. 41. Caso I<br />Paciente de 33 años, mujer,<br />Cefalea holocraneal<br />Características del dolor: no bien definido<br />Fotofobia<br />Fonofobia<br />Náuseas<br />Empeora con el esfuerzo físico<br />
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  44. 44. Caso II<br />Paciente mujer de 42 años, que mientras practica carrera de fondo siente dolor súbito frontoparietal muy intenso desde el inicio.<br />No refiere antecedentes personales ni familiares de interés.<br />Consciente en todo momento con sensación de dolor grave.<br />
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  47. 47. Caso III<br />Cefalea crónica diaria<br />Mujer de 52 años<br />Abuso de analgésicos<br />Debuta con diplopid y afasia.<br />
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  52. 52. NO OLVIDEN LIKELIHOOD RATIO<br />

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