Exploracion basada en la evidencia
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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