PROBLEM X

PICO
According to the problems, PICO can be described as follows:
P (Patient/Problem) : neonates and infants suspected for meningitis
I (Intervention) : cranial ultrasonography
C (Comparison) :-
O (Outcome) : meningitis diagnosis
CLINICAL QUESTION
In neonates and infants suspected for meningitis, can cranial ultrasonography help with
diagnosis of meningitis?
JOURNAL SEARCHING STRATEGY
Keywords: neonates AND infants AND cranial ultrasonography AND diagnosis AND
meningitis

RESULT
"Cranial Ultrasonography in Evaluation of Meningitis in Neonates and Infants"
Patel K, Rathore R, Chaudhuri CR
International Journal of Contemporary Medicine Surgery and Radiology. 2019: Vol.4

ABSTRACT
Background: Meningitis is an important cause of newborn and infant mortality and
morbidity. Early diagnosis and timely appropriate treatment of the complications can reduce
the morbidity and mortality to a considerable extent. Sonography is an ideal method for early
detection of complications and follow-up for meningitis patients.
Methods: Sample size of the study is 26 patients, performed in the department of Radio-
diagnosis, Dhiraj Hospital, S.B.K.S. Medical Institute and Research Centre, Pipariya,
Vadodara. The study is observational, descriptive hospital-based study. Sonograms were
obtained in newborn within 72 hours of birth, and repeated on 7th, 14th or at an early date, if
required. The patients were evaluated for presence of echogenic sulci, parenchymal
echogenicity, size of the ventricles, presence of ventriculitis, extra axial fluid collection, and
for evidence of abscess, infarcts, or encephalomalacia.
Results: Out of 26 patients, 5 (19.33%) patients were normal on ultrasonography despite
clinical and biochemical profile on meningitis. 21 (80.67%) patients were having imaging
findings of meningitis
Conclusion: Cranial ultrasonography in newborns and infants is a rapid, safe, and effective
method for initial diagnosis, to identify complications and plan treatment of meningitis, even
when sign symptoms are vague or nonspecific.

Evidence-based Critical Appraisal

(Descriptive Aspect)
Are the results of this descriptive study valid?
1. Does the research address a clearly Yes, the addressed population and
focused problem? problem were suspicion of meningitis in
 Study population neonates and infants and cranial
 Measures of health studied (eg, ultrasonography.
risk factors, prevention, outcomes)

2. Does the author use the right method to Yes, the research was done without a
answer their questions? control group in patient care settings and
 Is descriptive research the right not looking for causation.
way to answer the question?
 Does it answer the study question?

3. Were subjects recruited in an acceptable Yes, all subjects were recruited in an

manner? acceptable manner.
 Is the sample representative of the
specified population?
 Is everyone included who should
be included?

4. Are measurements measured accurately to Yes, measurements are made accurately

reduce bias? using subjective and objective
 Do they use subjective or measurements.
objective measurements?
 Does the measurement reflect
 what you want (is it validated)?

5. Was the data collected in the right way to Yes, data were collected in the right way
address the research problem?
 Correct data collection techniques
 Means of data collection are clear
(e.g. interviews, questionnaires,
chart reviews)
 The researcher has justified the
chosen method

6. Does this research have enough subjects? No, because there are confounding factors
 The results are precise enough to that still need further investigation.
make a decision Calculation of power has not been
 There is a power calculation. This explained in the research.
will estimate how many subjects
are needed to produce a reliable
estimate of the desired size.

This study is valid

Are the valid results of this descriptive study important?

1. How are the results presented and what are Yes, the results have been presented in
the main results? proportions.

 Outcomes are presented as the

proportion of people experiencing
an outcome (risk) or as a measure
(difference in median means).

 How big is this outcome measure

and how meaningful is it

 How would you summarize the

results of the experiment in one
sentence
2. Is data analysis rigorous enough? Yes, data analysis has been done quite
  There is an in-depth description of
the analysis process
rigorously
 Sufficient data are presented to
support the findings

3. Is there a clear statement of findings? Yes, the findings are clearly supported
 The results obtained are clear by evidence supporting or against the
 There is adequate discussion of the researcher's argument.
evidence for and against the
researcher's argument
 Researchers discuss the credibility
of their findings
 Findings are discussed in relation to
the original research question

This study is important

Can we apply this valid, important evidence in caring for our patient?
1. Are the results applicable to the Yes, the subject matter and general
population? medical treatment are applicable.
 The subjects covered in this study
may be different enough from your
population to cause concern
 Your local medical policy will
likely be significantly different
from this study

2. How valuable is the research? Yes, this evidence is worth for our clinical
 Researchers discuss the research's practices to be able to identify meningitis
contribution to existing knowledge early.
(e.g. do they consider findings in
relation to current practice or
policy, or relevant research-based
literature?)
  Researchers have discussed
whether or how the findings can
be transferred to other populations

This study is applicable

Conclusion: Valid, Important, and Applicable.

Level of evidence 2C, Grade of recommendation C.