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Avaliação crítica e implementação prática de estudos sobre a validade de testes diagnósticos – Parte II
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Abstract(s)
RESUMO A Medicina Baseada na Evidência
(MBE) é genericamente definida como a
aplicação consciente, explícita e criteriosa
da melhor evidência científica disponível
na tomada de decisões sobre o cuidado
individual dos doentes. Nesta série
de Pediatria Baseada na Evidência têm
vindo a ser abordados os aspectos conceptuais,
metodológicos e operacionais
relativos à prática da MBE. Neste artigo é
apresentada a segunda parte do exemplo
prático sobre a avaliação crítica e aplicação
prática de estudos sobre a validade
de testes diagnósticos iniciado no artigo
anterior desta série. Nesta segunda parte
é dada continuidade à discussão do cenário
clínico previamente apresentado e
em que existia a necessidade de encontrar
e avaliar a evidência sobre a validade
e utilidade da procalcitonina sérica na
distinção entre pneumonia de etiologia
bacteriana e vírica em crianças. No artigo
anterior foram discutidos métodos de
pesquisa da evidência e foi sugerida uma
metodologia sistemática para a avaliação
crítica de estudos sobre a validade de
testes diagnósticos, incluindo três fases:
(1) avaliação da qualidade metodológica
do estudo; (2) avaliação da importância
científica e prática dos seus resultados
e (3) avaliação da aplicabilidade prática
dos mesmos. Depois de no artigo anterior
terem sido abordadas as questões relativas
à primeira destas fases, no presente
artigo são abordados os métodos, conceitos
e critérios necessários para a avaliação
da importância científica e prática dos resultados (características operacionais
dos testes diagnósticos e aplicação
da informação diagnóstica no processo
de tomada de decisão clínica numa perspectiva
bayesiana) e da aplicabilidade
prática dos mesmos.
ABSTRACT Evidence Based Medicine (EBM) is generically defined as the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. This section of Evidence Based Paediatrics has been covering the conceptual, methodological and operational issues related to the practice of EBM in the field of Paediatrics. In the present article we will continue the discussion of the practical example regarding the critical appraisal and practical implementation of diagnostic tests accuracy studies initiated in the previous article of this section. In the present article we will continue the discussion of a clinical scenario where we have searched for and critically appraise scientific evidence about the accuracy of serum procalcitonin in the distinction of bacterial from viral pneumonia in children. In the last article methods for searching the current best evidence were discussed and a systematic approach for the critical appraisal of diagnostic tests accuracy studies was suggested, including: (1) assessment of the methodological quality of the study; (2) assessment of the scientific and practical impact of its results and (3) assessment of their practical applicability. After discussing in the past article the fi rst of this points, in the present article we will be covering methods and concepts concerning the assessment of scientific and practical impact of results (operational characteristics of diagnostic tests and integration of diagnostic information in the clinical decision making process in a bayesian perspective) and their practical applicability.
ABSTRACT Evidence Based Medicine (EBM) is generically defined as the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. This section of Evidence Based Paediatrics has been covering the conceptual, methodological and operational issues related to the practice of EBM in the field of Paediatrics. In the present article we will continue the discussion of the practical example regarding the critical appraisal and practical implementation of diagnostic tests accuracy studies initiated in the previous article of this section. In the present article we will continue the discussion of a clinical scenario where we have searched for and critically appraise scientific evidence about the accuracy of serum procalcitonin in the distinction of bacterial from viral pneumonia in children. In the last article methods for searching the current best evidence were discussed and a systematic approach for the critical appraisal of diagnostic tests accuracy studies was suggested, including: (1) assessment of the methodological quality of the study; (2) assessment of the scientific and practical impact of its results and (3) assessment of their practical applicability. After discussing in the past article the fi rst of this points, in the present article we will be covering methods and concepts concerning the assessment of scientific and practical impact of results (operational characteristics of diagnostic tests and integration of diagnostic information in the clinical decision making process in a bayesian perspective) and their practical applicability.
Description
Keywords
Medicina baseada na evidência diagnóstico testes diagnósticos especificidade sensibilidade valores preditivos razões de verosimilhança curvas ROC procalcitonina pneumonia criança Evidence based medicine diagnosis diagnostic tests specificity sensitivity predictive values likelihood ratios ROC curves procalcitonin pneumonia children
Citation
Nascer e Crescer 2010; 19(4): 265-277