dr.

Afprimadhona
04102781923003
Anestesiologi dan Terapi Intensif

DIAGNOSIS WORKSHEET

Citation:
Rapid Diagnosis of Childhood Pulmonary Tuberculosis by Xpert MTB/RIF Assay Using
Bronchoalveolar Lavage Fluid.

Are the results of this diagnostic study valid?

Was there an independent, blind Yes, This journal mention they used “gold
comparison with a reference (“gold”) standart” with Composite Clinical Reference
standard of diagnosis? Standard (CCRS) 8 item

Was the diagnostic test evaluated in an Yes. The diagnostic test evaluated
appropriate spectrum of patients (like
those in whom it would be used in
practice)?
Was the reference standard applied Yes, It Was.
regardless of the diagnostic test result?
Was the test (or cluster of tests) validated Yes, they were.
in a second, independent group of
patients?

Are the valid results of this diagnostic study important?

Yes. They are.

YOUR CALCULATIONS

1. Xpert MTB/RIF Assay

Target disorder
(Pulmonary Tuberculosis)
Totals
Present Absent

Diagnostic Positive 44 0 44
test result
(Xpert
MTB/RIF 168 207
Negative 39
assay)

Totals 83 168 251

Sensitivity = a/(a+c) = 44/83 = 53%
Specificity = d/(b+d) = 168/168 = 100%
Likelihood ratio for a positive test result = LR+ = sens/(1-spec) = 53%/0% = ~
Likelihood ratio for a negative test result = LR - = (1-sens)/spec = 47%/100% = 0.47
Positive Predictive Value = a/(a+b) = 44/44= 100%
Negative Predictive Value = d/(c+d) = 168/207 = 81.2%
 dr. Afprimadhona
04102781923003
Anestesiologi dan Terapi Intensif

Pre-test probability (prevalence) = (a+c)/(a+b+c+d) = 83/168 = 49.4%

Pre-test odds = prevalence/(1-prevalence) = 49.4%/50.6% = 0.97
Post-test odds = pre-test odds  LR  0.97 x 0.47 = 0.4559
Post-test probability = post-test odds/(post-test odds +1)  0.4559/1.4559 = 0.31

2. MTB Culture

Target disorder
(Pulmonary Tuberculosis)
Totals
Present Absent

Diagnostic Positive 24 0 24
test result
(MTB
Culture)
Negative 59 168 227

Totals 83 168 251

Sensitivity = a/(a+c) = 24/83 = 28.9%
Specificity = d/(b+d) = 168/168 = 100%
Likelihood ratio for a positive test result = LR+ = sens/(1-spec) = 28.9%/0% = ~
Likelihood ratio for a negative test result = LR - = (1-sens)/spec = 71.1%/100% = 0.71
Positive Predictive Value = a/(a+b) = 24/24 = 100%
Negative Predictive Value = d/(c+d) = 186/227 = 74%
Pre-test probability (prevalence) = (a+c)/(a+b+c+d) = 83/251 = 33%
Pre-test odds = prevalence/(1-prevalence) = 33%/67% = 0.49
Post-test odds = pre-test odds  LR  0.49x0.71 = 0.3479
Post-test probability = post-test odds/(post-test odds +1)  0.3479/1.3479 = 0.258

3. AFB Microscopy

Target disorder
(Pulmonary Tuberculosis)
Totals
Present Absent

Diagnostic Positive 7 0 7
test result
(AFB
micros
Negative 76 168 244
copy)

Totals 83 168 251

Sensitivity = a/(a+c) = 7/83 = 8.4%
Specificity = d/(b+d) = 168/168 = 100%
 dr. Afprimadhona
04102781923003
Anestesiologi dan Terapi Intensif

Likelihood ratio for a positive test result = LR+ = sens/(1-spec) = 8.4%/0% = ~

Likelihood ratio for a negative test result = LR - = (1-sens)/spec = 91.6%/100% =
0.916
Positive Predictive Value = a/(a+b) = 7/7 = 100%
Negative Predictive Value = d/(c+d) = 168/244 = 68.8%
Pre-test probability (prevalence) = (a+c)/(a+b+c+d) = 83/251= 3.2%
Pre-test odds = prevalence/(1-prevalence) = 3.2%/96.8% = 0.03
Post-test odds = pre-test odds  LR  0.03 x 0.916 = 0.02748
Post-test probability = post-test odds/(post-test odds +1)  0.02748/1.02748 = 0.0267

Can you apply this valid, important evidence about a diagnostic test in caring for
your patient?

Is the diagnostic test available, affordable, Not All diagnostic test.

accurate, and precise in your setting?
Can you generate a clinically sensible Yes It can.
estimate of your patient’s pre-test probability
(from personal experience, prevalence
statistics, practice databases, or primary
studies)?
 Are the study patients similar to your Yes. They are.
own?
 Is it unlikely that the disease possibilities It can be.
or probabilities have changed since the
evidence was gathered?
Will the resulting post-test probabilities Yes I agree
affect your management and help your
patient?
 Could it move you across a test- Yes. available, affordable, accurate,
treatment threshold? and precise.
 Would your patient be a willing partner This is a hope to get fast diagnosis so
in carrying it out? we can management earlier.
Would the consequences of the test help We can fast diagnosis childhood PTB
your patient?

Additional notes:

PROGNOSIS WORKSHEET

Citation:
PLA1A2 platelet polymorphism predicts mortality in prediabetic subjects of the population
based KORA S4-Cohort
Are the results of this prognosis study valid?
Was a defined, representative sample of
patients assembled at a common (usually
early) point in the course of their disease?
Was patient follow-up sufficiently long
and complete?
Were objective outcome criteria applied in
a “blind” fashion?
If subgroups with different prognoses are
identified, was there adjustment for
important prognostic factors?
Was there validation in an independent
group (“test set”) of patients?
Are the valid results of this prognosis study important?
How likely are the outcomes over time?
How precise are the prognostic
estimates?
If you want to calculate a confidence interval around the measure of prognosis:
dr. Afprimadhona
04102781923003
Anestesiologi dan Terapi Intensif
Yes, the author mentioned representative
sample of patients.
Yes, they followed-up within 10 years
No “blind” fashion in this journal.
Yes. Model was adjusted for age, sex, waist-
hip ratio, blood pressure (diastolic and
systolic), cholesterol (total, HDL, LDL),
smoking status (categorized: non-smoker,
former smoker, current smoker), alcohol
intake categorized: ≥20 g/day for women;
≥40 g/day for men), physical activity
(categorized: >1 h per week)
Yes, There was.
PLA2 significantly correlates with mortality in
nondiabetics with HbA1c values of >5.5% (37
mmol/mol) up to 6.5% (48 mmol/mol), including
the prediabetic subjects. Elevated blood
glucose levels beyond the diabetic threshold
are a powerful predictor of 30 day mortality in
acute heart failure patients, emphasizing the
critical role of the prediabetic state
Our results suggest the need for a graded
interventional hierarchy supporting antiplatelet
therapy in nondiabetics, maintenance of
euglycemia and antiplatelet therapy in
prediabetic AxA2 subjects whereas in manifest
diabetes euglycemia is recommended as the
most important therapeutic aim.
 dr. Afprimadhona
04102781923003
Anestesiologi dan Terapi Intensif

Clinical Measure Standard Error (SE) Typical Calculation of CI

Proportion (as in the rate of
some prognostic
event, etc.) where:
the number of patients = n
the proportion of these patients who
experience the event = p
If p = 4261/6640 = 0.64 (or
64%) and n = 6640
 p  (1  p ) / n
SE =
where p is proportion and  0.64  (1  0.64) / 6640
n is number of patients = 0.0059 (or 0.59%)

n from your evidence: 6640 Your calculation:

p from your evidence: 4261 SE: 0.59%
95% CI is 64% ±1.96 × 0.59%
or 62.84% to 65.16%

Can you apply this valid, important evidence about prognosis in caring for your
patient?

Were the study patients similar to your Yes. It was

own?
Will this evidence make a clinically Yes. This is important impact
important impact on your
conclusions about what to offer or
tell your patient?

Additional notes: