EBM Prognostic Ujian

EBM prognostic
DHF
R. PRINDJATI PRAKASA
H2A010042
Skenario klinis
Seorang anak 15 tahun datang ke dokter dengan
mimisan. Dari anamnesis didapatkan riwayat trauma (-),

demam 3 hari, mual muntah (+), hepatomegali, tes
ptekie (+). Dokter mencurigai pasien menderita DBD.
Dokter menyarankan pasien untuk pemeriksaan serologi
untuk memastikan penyebab penyakitnya dan darah
rutin untuk memberi keputusan rawat inap.
Setelah dilakukan pemeriksaan pasien (+) DBD dan
ditemukan trombositopenia.
Pasien disarankan rawat inap dan
Dokter ingin tahu apakah profil transfusi (menerima
transfusi trombosit) dan manifestasi klinis DBD
menghasilkan karakteristik klinik dan laborat yang baik?
Practice of EBM
3
Step 1: Converting the need for information (about
prevention, diagnosis, prognosis, therapy, causation, etc.)

into an answerable question
Step 2: Tracking down the best evidence with which to
answer that question
Step 3: Critically appraise that evidence for the validity
(closeness to the truth), impact (size of the effect), and
applicability (usefulness in our clinical practice)
Step 4: Integrating the critical appraisal with our clinical
expertise and with our patients unique biology, values,
and circumstances
Step 5: Evaluating our effectiveness and efficiency in
executing steps 1-4 and seeking ways to improve them
both for next time
Clinical question about prognosis

Patient or Intervention
Problem
Pasien
anak 15
tahun
Comparison Outcomes
Manifestasi
klinik DBD &
profil
transfusi
(menerima
transfusi
trombosit)
karakteristik
klinik dan
hasil
laboratorium
yang baik
Pertanyaan klinis
Apakah manifestasi klinik DBD & profil transfusi
(menerima transfusi trombosit) pada pasien anak

15 tahun dapat menghasilkan karakteristik klinik
dan hasil laboratorium yang baik?
Practice of EBM
6

and circumstances
both for next time
Search Strategy
Medline database:
http://www.ncbi.nlm.nih.gov/pubmed/
Using the Clinical Queries function of PubMed:
Key words:
dengue hemorragic
Clinical Study Categories: prognosis

Scope: Narrow
Searching the Evidence

8
Clinical and laboratory characteristics of
patients with dengue hemorrhagic fever

manifestations and their transfusion profile
Fujimoto, D. E., Koifman S.
Rev Bras Hematol Hemoter. 2014: 36(2):115120
Practice of EBM
9 information (about
Step 1: Converting the need for

and circumstances
both for next time
Is this evidence about prognosis valid?

10
1.
Was a defined, representative sample of patients assembled at a

common point in the course of their disease?
Penelitian ini menggunakan metode studi deskriptif
retrospektif
Sample penelitian ini diambil dari satu tempat yaitu di
daerah Rio Branco

11
2.
Was follow-up of study patients sufficiently long and complete?

Dari 90.553 kasus dengue, follow-up
terhadap 14.985 pasien (pemeriksaan
serologi dilakukan) yang diambil dari
3 Januari 2007 14 Juni 2011
dengan kematian pasien sebanyak 14
orang

12
2.
Was follow-up of study patients sufficiently long and

complete? (contd)
Pada akhir pengamatan penelitian ini jumlah sampel semuanya

utuh karena pengambilan data menggunakan metode
retrospektif dimana menggunakan rekam medis

13
3. Were objective outcome criteria applied in a blind

fashion?
Pada penelitian ini ,

total
akhir
dari
karakteristik klinik dan
laborat tidak dijelaskan
secara rinci.
Penyebab karakteristik
klinik
dan
laborat
dilihat melalui rekam
medis dari pelayanan
kesehatan

14
3. Were objective outcome criteria applied in a

blind fashion?
Pada penelitian ini , karakteristik klinik dijelaskan
sebagian kecil sedanagkan karakteristik laborat
dijelaskan secara detail

4.
15
If subgroups with different prognoses are identified:

Was there adjustment for important prognostic factors?
Was there validation in an independent group of
test-set patients?
Tidak ada test-set pasien dalam penelitian ini
Is this valid evidence about prognosis

important?
17
1.
2.
How likely are the outcomes over time?

How precise are the prognostic estimates?
Dari kasus ini, ditemukan bahwa follow up dilakukan

selama 3 Januari 2007 14 Juni 2011 dengan ditemukan
kasus sebanyak 90.553. dan kematian sebesar 7,3%
Dari 90.553 kasus DBD, dibagi 2 kelompok yaitu dengan
tes serologi dan tanpa tes serologi. Pasien dengan tes
serologi dikelompokkan kembali menjadi positif, negatif
dan tak tergolongkan. Dari pasien serologi (+)
didapatkan 267 pasien dengan DBD dimana mereka yang
akan dijadikan sampel penelitan
Can we apply this valid, important evidence about

prognosis to our patient?
19
1.
Is our patient so different from those in the study

that its results cannot apply?
Ya, karena dari kesimpulan penelitan ini tidak ada

hubungan antara pemberian transfusi dengan
karakteristik klinik dan hasil laboratorium
2. Will this evidence make a clinically important

impact on our conclusions about what to offer or
tell our patient?
tidak
Practice of EBM
20

and circumstances
both for next time
Resolution of the Case

21
Pasien anak usia 15 tahun yang terdiagnosa DBD yang

diberikan transfusi trombosit tidak menurunkan risiko
dari karakteristik klinik maupun hasil laboratorium
yang mengakibatkan kematian

EBM Prognostic Ujian

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EBM Prognostic Ujian

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EBM prognostic

mimisan. Dari anamnesis didapatkan riwayat trauma (-),

Step 1: Converting the need for information (about

prevention, diagnosis, prognosis, therapy, causation, etc.)

Clinical question about prognosis

(menerima transfusi trombosit) pada pasien anak

Step 1: Converting the need for information (about

prevention, diagnosis, prognosis, therapy, causation, etc.)

Clinical Study Categories: prognosis

Searching the Evidence

Clinical and laboratory characteristics of

patients with dengue hemorrhagic fever

prevention, diagnosis, prognosis, therapy, causation, etc.)

Is this evidence about prognosis valid?

Was a defined, representative sample of patients assembled at a

Is this evidence about prognosis valid?

Was follow-up of study patients sufficiently long and complete?

Is this evidence about prognosis valid?

Was follow-up of study patients sufficiently long and

Pada akhir pengamatan penelitian ini jumlah sampel semuanya

Is this evidence about prognosis valid?

3. Were objective outcome criteria applied in a blind

Pada penelitian ini ,

Is this evidence about prognosis valid?

3. Were objective outcome criteria applied in a

Is this evidence about prognosis valid?

If subgroups with different prognoses are identified:

Was there validation in an independent group of

Is this valid evidence about prognosis

How likely are the outcomes over time?

Dari kasus ini, ditemukan bahwa follow up dilakukan

Can we apply this valid, important evidence about

Is our patient so different from those in the study

Ya, karena dari kesimpulan penelitan ini tidak ada

2. Will this evidence make a clinically important

Step 1: Converting the need for information (about

prevention, diagnosis, prognosis, therapy, causation, etc.)

Resolution of the Case

Pasien anak usia 15 tahun yang terdiagnosa DBD yang

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