Avaliação crítica de artigos sobre diagnóstico

Tamanho: px

Começar a partir da página:

Download "Avaliação crítica de artigos sobre diagnóstico"

Pedro Ferreira Bastos
7 Há anos
Visualizações:

1 Avaliação crítica de artigos sobre diagnóstico Objetivos da aula Formulação da pergunta Identificação e seleção do estudo Roteiro de avaliação da qualidade de um artigo sobre diagnóstico Sintetizando informações de vários artigos 1/36 2/36 Formulação da pergunta Situação Clínica Procedimento Tipo de Estudo 3/36 4/36 5/36 Identificação dos Estudos Textwords sensitivit: specificit: predictive and value: false and reaction: likelihood and ratio: ACP Journal Club 1994;121(1):A-10. MeSH sensitivity and specificity predictive value of tests ROC curve false negative reaction false positive reaction diagnosis, differential mass screening diagnostic use (sh) diagnosis* (sh) 6/36 Identificação dos Estudos Before 1990 Sensitivity Specificity sensitivity (tw) 43% 98% diagnosis& & ( px) 91% 62% 1990 and on Sensitivity Specificity sensitivity (tw) 57% 97% diagnosis& & ( px) 80% 77% ACP Journal Club 1994;121(1):A-10. 1

2 Seleção dos Estudos Universo Local Amostra Recusou participar Critérios de exclusão Teste diagnóstico Perdas Exclusões Padrão ouro T e m p o 7/36 8/36 S y s t e m a t i c R e v i e w s 9/36 Cohort studies Case control studies Case series Case reports Animal research In vitro ( Test tube ) research Randomized Controlled Trials 10/36 1a Systematic Review (with homogeneity*) of Level 1 diagnostic studies; or a CPG validated on a test set 1b 1c Independent blind comparison of an appropriate spectrum of consecutive patients, all of whom have undergone both the diagnostic test and the reference standard. Absolute SpPins and SnNouts 11/36 12/36 2

3 2a 2b Systematic review (with homogeneity) of Level >2 diagnostic studies Independent blind comparison but either in non-consecutive patients, or confined to a narrow spectrum of study individuals (or both), all of whom have undergone both the diagnostic test and the reference standard; or a diagnostic CPG not validated in a test set. 13/36 14/36 3b 4 Independent blind comparison of an appropriate spectrum, but the reference standard was not applied to all study patients Reference standard was not applied independently or not applied blindly 15/36 16/36 5 Roteiro de Avaliação (Princípios) Expert opinion without explicit critical appraisal, or based on physiology, bench research or "first principles" Validade Importância Aplicabilidade 17/36 18/36 JAMA 1993;270(17):

4 Aula em um diapositivo Users guides to the medical literature. How to use an article about a diagnosis test. JAMA 1994;271(9): Aula em um diapositivo Users guides to the medical literature _all.asp 19/36 20/36 Are the Results Valid? Are the Results Valid? Primary Guides Reference standard Appropriate spectrum of patients Secondary Guides Influence the decision Sufficient detail to permit replication Was there an independent, blind comparison with a reference standard? 21/36 22/36 Are the Results Valid? Did the patient sample include an appropriate spectrum of patients to whom the diagnostic test will be applied in clinical practice? Are the Results Valid? Did the results of the test being evaluated influence the decision to perform the reference standard? 23/36 24/36 4

5 Are the Results Valid? Were the methods for performing the test described in sufficient detail to permit replication? What are the Results? Are likelihood ratios for the test results presented or data necessary for their calculation provided? 25/36 26/36 JAMA 1994;271(9): Teste + - Padrão Ouro + - VP FP FN VN Will the Results Help me in Caring for my Patients? Will the reproducibility of the test result and its interpretation be satisfactory in my setting? 27/36 28/36 JAMA 1994;271(9): Will the Results Help me in Caring for my Patients? Sintetizando informações de vários estudos de acurácia Are the results applicable to my patient? Will the results change my management? Will patients be better off as a result of the test? 29/36 JAMA 1994;271(9): /36 5

6 Fig. 1 Summary receiver operator characteristic curve for sinus radiography, compared with sinus puncture/aspiration for diagnosis of acute sinusitis Engels EA et al. Metaanalysis of diagnostic tests for acute sinusitis. J Clin Epidemiol 2000;53(8): /36 Recursos na internet 32/36 33/36 34/36 35/36 36/36 6

7 37/36 38/ /36 40/ /36 42/36 7

8 43/36 44/36 45/36 46/36 47/36 48/36 8

9 49/36 The likelihood of the trials design to generate unbiased results Jadad et al. Control Clin Trials 1996 Feb;17(1):1-12. Dimensions of Quality Quality The greater the scientific quality (i.e. methologic rigor), the more likely an overview is to avoid bias, and its findings to reflect the truth. Oxman AD, Guyatt GH. J Clin Epidemiol 1991;44(11): Internal validity External validity Statistical analysis 50/36 Quality Quality is a set of parameters in the design and conduct of a study related to effect sizes. Verhagen et al. J Clin Epidemiol 1998;51(12): Quality is a set of parameters in the design and conduct of a study that reflects the validity of the outcome, related to the external and internal validity and the statistical model used. Verhagen et al. J Clin Epidemiol 1998;51(12): A scientific study ultimately contribute only a piece of an enormous puzzle Mulrow CD. Rationale for systematic reviews. BMJ 1994 Sep 3;309(6954): Como citar: Castro AA. Avaliação da qualidade de artigos sobre diagnóstico [Diapositivos de aula]. São Paulo, Disponível em: URL: Data da última modificação: 27/03/2001. Conflito de interesse: nenhum Fonte de fomento: Universidade Federal de São Paulo /Escola Paulista de Medicina 51/36 52/36 9

Documentos relacionados

Evidence-Based Medicine

Evidence-Based Medicine Princípios Apresentações SRHUC 2 Dezembro 2012 men are generally ready to believe what they want to believe! Julius Caesar De Bello Gallica (ca BC 55) 1 Principles of EBM Evidence-based