Jurnal Diagnostik - Wening CHD

KAJIAN KRITIS JURNAL DIAGNOSTIK
RR WENING GELAR PRATIDINA

TAHAP MADYA
Med J Indones. 2019;28:338-44

Skenario Klinis
Pertanyaan Klinis
Bagaimana nilai diagnostik pemeriksaan

Analisis PICO
P Asy
I
C Echocardiographic
O CHD
Pencarian Literatur
Strategi Pencarian
Kata kunci:
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Publication dates: 5 years
Latar Belakang
Tujuan
assess whether umbilical blood cord PCT concentration could be

an early marker of EOS in extremely preterm infants.
Secondary objective was to investigate an association between
PCT concentrations at birth with antenatal characteristics, clinical
chorioamnionitis, postnatal morbidities, and neonatal mortality.
Metode Penelitian
Lokasi Penelitian
Robert Debré University Children’s
Hospital, Paris, France
Desain Uji
monocentric observational prospective
analysis of collected data from September
2008 to March 2017
Metode Penelitian
Kriteria Inklusi
1All extremely preterm neonates born between 240/7 weeks and

276/7 weeks with cord blood PCT lab testing were included in the
study
Kriteria Eksklusi
tidak ada
Pemilihan subjek
Data were recorded in a customized database at the time of newborn discharge.
Maternal data included ethnic group, presence of diabetes, or high blood
pressure.
Perinatal data included tocolysis, antenatal antibiotics and
glucocorticoidsexposure, clinical chorioamnionitis defined by maternal fever and
uterine contractions, prolonged membrane rupture (more than 24 h before birth),
analgesia and mode of delivery, gestational age at birth, birthweight, multiple
pregnancy, and APGAR score at 5 min of life.
Biological data included cord blood PCT at birth and CRP serum concentrations
at birth and at 24 h of life (cutoff for elevated CRP was ≥ 10 mg/L), gastric fluid,
blood and cerebrospinal fluid sampling.
The following postnatal complications of prematurity were collected: death,
bronchopulmonary dysplasia (BPD) defined using a standardized oxygen-reduction
test performed at 36 weeks of postmenstrual age, severe intraventricular
hemorrhage (IVH) grade 3 or 4 according to Papile’s classiffication, NEC ≥ 2a
according to Bell’s classification, surgery of patent ductus arteriosus, and LOS
defined by the detection of a bacterial pathogen in the blood after 72 h of life
requiring antibiotic treatment for more than 72 h
Karakteristik dasar dan karakteristik
klinis dari subjek penelitian
Hasil
Kesimpulan
KAJIAN KRITIS JURNAL
BOX I BOX II BOX III
Representativeness Does this (valid) evidence Is the diagnostic test
Was the diagnostic test demonstrate an important available, affordable,
evaluated in an appropriate ability of this test to accurate, and precise in
spectrum of patients (like
accurately distinguish our setting?
those in whom we would
use it in practice)?
patients who do and don't
have a specific disorder? Can we generate a
Ascertainment clinically sensible
Was the reference standard estimate of our patient's
ascertained regardless of pretest probability?
the diagnostic test result?
Will the resulting posttest
Measurement
Was there an independent,
probabilities affect our
blind comparison with a management and help
reference standard? our patient?
Validasi: 1. Was the diagnostic test evaluated in a
representative spectrum of patients (like those in whom
it would be used in practice)?
All extremely preterm neonates born between 240/7 weeks and
276/7 weeks with cord blood PCT lab testing were included in
the
study.
-Methods
Validasi: 2. Was the reference standard applied
regardless of the diagnostic test result?
Ya,
“EOS was a posteriori defined by a positive culture of central (blood or cerebrospinal

fluid) samples (definite EOS) or by the association of postnatal biological (leukopenia <
5000/mm3 or hyperleukocytosis ≥ 21,000/mm3 , CRP > 10 mg/dL, PCT is excluded) and
clinical signs of sepsis (as lethargy, hypother_x0002_mia, poor feeding, respiratory and
cardiac symptoms includ_x0002_ing apnea, grunting, cyanosis, desaturation,
bradycardia, poor perfusion, and hypotension) or a microbiological
identifica_x0002_tion of a pathogen in the gastric aspirate and antibiotic
treat_x0002_ment for more than 72 h (probable EOS)” - Methods
Validasi: 3. Was there an independent, blind
comparison between the index test and an appropriate
reference ('gold') standard of diagnosis?
Clinicians were informed of PCT value, but it was not used as a criterion for
diagnosis and therapeutic decision
Valid
Signifikansi: Does this (valid) evidence demonstrate an
important ability of this test to accurately distinguish
patients who do and don't have a specific disorder?
EOS Total
positive negative
procalcitoni positive
n negative
Total
Sensitivity: a / (a+c) x 100% = %
Specificity: d / (b+d) x 100% = %
Negative predictive value: d / (c+d) x 100% = %
Positive predictive value: a / (a+b) x 100% = %
Likelihood ratio for positive result: sensitivity/(1-specificity) =
Likelihood ratio for negative result: (1-sensitivity)/specificity =
Pre-test probability (prevalence): (a+c) / (a+b+c+d) x 100% = %
Pretest-odds: prev/(1-prev) = 0.86/(1-0.86) =
Post-test-odds: Pretest odds x LR = 6,1 x 1,47 =
Post-test probability: post-test odds/(post-test odds+1) x 100% = %
Accuracy: (a+d) / (a+b+c+d) = 35/68 x 100% = %
Youden Index: sensitivity + specificity - 100% = %
PRE-TEST
%
LIKELIHOOD
RATIO
POST-TEST
%
http://araw.mede.uic.edu/cgi-bin/testcalc.pl
Penting
Relevansi 1: Is the diagnostic test available, affordable,
accurate, and precise in our setting?
Ya.
Relevansi 2: Can we generate a clinically sensible
estimate of our patient's pretest probability?
a. Is it based on personal experience, prevalence statistics, practice

databases, or primary studies?
Relevansi 2: Can we generate a clinically sensible
estimate of our patient's pretest probability?
b. Are the study patients similar to our own?

Ya, pasien pada studi ini mirip dengan pasien kita. Karakteristik pasien
yang dilakukan pemeriksaan sama karena dilakukan pada
Relevansi 3a: Could it move us across a test-
treatment threshold?
Tidak. Penelitian ini memiliki likelihood positive 1,47 sehingga
pretest probability 86,76% menjadi posttest probability 89,9%
sehingga tidak melewati treatment threshold
Relevansi 3b: Would our patient be a willing partner in carrying
it out?
Ya. bisa jadi

Relevansi 3c: Would the consequences of the test help our
patient reach his or her goals in all this?
Dapat
diterapkan
Kesimpulan
Kekurangan penelitian
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KAJIAN KRITIS JURNAL DIAGNOSTIK

RR WENING GELAR PRATIDINA

Med J Indones. 2019;28:338-44

Bagaimana nilai diagnostik pemeriksaan

assess whether umbilical blood cord PCT concentration could be

1All extremely preterm neonates born between 240/7 weeks and

“EOS was a posteriori defined by a positive culture of central (blood or cerebrospinal

a. Is it based on personal experience, prevalence statistics, practice

b. Are the study patients similar to our own?

Ya. bisa jadi

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