Critical appraisal of Prognostic studies

Are the results of the study valid? (Internal Validity)

1.Was the defined representative sample of patients assembled at a
common (usually early) point in the course of their disease)?
What is best?
Where do I find the information?
It is preferable if study patients are The Methods section should describe
enrolled at a uniformly early time in the the stage at which patients entered the
disease usually when disease first study (e.g., at the time of first
becomes manifest. Such groups of myocardial infarction; Stage 3 breast
patients are called an inception cancer). The Methods section should
cohort. Patients should also be also provide information about patient
representative
of
the
underlying recruitment, whether patients were
population. Patients from tertiary recruited from primary care or tertiary
referral centres may have more referral centres.
advanced
disease
and
poorer
prognoses than patients form primary
care.
This Paper: Yes
No
Unclear
Comment:
Pada penelitian ini dijelaskan pasien berasal dari tiga rumah sakit universitas
antara tahun 1997 dan 2013, diteliti secara retrospektif dengan sampel 95
episode penyakit demam akut pada 88 pasien thalassemia (laki-laki, 48;
perempuan, 40) Usia rata-rata mereka adalah 11,6 tahun (kisaran 2,0-19,9).
Jenis-jenis thalassemia termasuk thalasemia mayor (n = 8), -thal / HbE (n =
32), penyakit AE Bart (n = 6), penyakit Hb H (n = 38), -thal / HbS ( n = 1),
penyakit thalasemia tidak spesifik (n = 1) dan homozigot Hb Constant Spring (n
= 2). Dua puluh empat pasien yang tergantung transfusi sedangkan pasien yang
tersisa adalah non-dependent-transfusi. Splenektomi dilakukan pada 9 pasien.
2. Was patient follow-up sufficiently
What is best?
Length of follow-up should be long
enough to detect the outcome of
interest. This will vary depending on
the outcome (e.g., for pregnancy
outcomes, nine months; for cancer,
many years). All patients should be
followed from the beginning of the
study until the outcome of interest or
death occurs. Reasons for non followup should be provided along with
comparison of the demographic and
clinical characteristics of the patients
who were unavailable and those in
whom follow-up was complete.
This Paper: Yes
No
Unclear

long and complete?

Where do I find the information?
The Results section should state the
median or mean length of follow-up.
The Results section should also provide
the number of and the reasons for
patients being unavailable for followup. A comparison of the two groups
(those available and those unavailable)
may be presented in table form or the
authors may simply state in the text
whether or not there were differences

Comment:
Pasien di follow-up ketat sampai dengan 24 jam setelah masa rekonvalesensi.
Tidak terdapat pembandingan dua kelompok pada penelitian ini.

3. Were outcome criteria either objective or applied in a blind fashion?

What is best?
Where do I find the information?
A clear definition of all outcomes The Methods section should provide a
should be provided. It is ideal if less clear definition or explicit criteria for
objective outcomes are assessed each
outcome
and
whether
blindly,
that
is,
the
individual determination is blinded to prognostic
determining the outcome does not factors will be found in either the
know whether the patient has a Methods or Results sections.
potential prognostic factor.
This Paper: Yes
No
Unclear
Comment:
4. If subgroups with different prognoses are identified, did adjustment
for important prognostic factors take place?
What is best?
Where do I find the information?
A prognostic factor is a patient The Results section should identify any
characteristic (e.g., age, stage of prognostic factors and whether or not
disease) that predicts the patients these have been adjusted for in the
eventual outcome. The study should analysis. Also look at the tables and
adjust for known prognostic factors in figures for evidence of this (e.g., there
the analysis so that results are not may be separate survival curves for
distorted.
patients at different stages of disease
or for different age groups).
This Paper: Yes
No
Unclear
Comment:
What are the results?
Hasilnya adalah delapan puluh dua episode didiagnosis dengan infeksi dengue
(DF 22, DBD 60: kelas I 23, II 20, III 13 dan IV 4 kasus), sedangkan 13 episode
didiagnosis dengan infeksi virus self-limited lainnya. Sebagian besar pasien
menunjukkan anemia karena hemolisis akut dan hemoglobinuria yang
menyebabkan hematokrit rendah dan membutuhkan transfusi sel darah merah.
Pada pasien terjadi peningkatan kadar AST dan ALT yang dihasilkan dari
keterlibatan hati. Delapan dari 82 kasus infeksi dengue menyebabkan komplikasi
IAHS (n = 1); kejang (n = 3) yang disebabkan oleh hiponatremia, ensefalitis dan
ensefalopati; dan gangguan hati berat (n = 4) menyebabkan ensefalopati
hepatik di 3 kasus. Rawat inap yang cepat dari pasien menggunakan pendekatan
multidisiplin untuk memantau dan memberikan cairan yang cukup dan terapi
penggantian sel darah merah dan kontrol perdarahan efektif menghasilkan hasil
yang sangat baik dengan tingkat kelangsungan hidup 100%
How likely are the outcomes over time?
Tidak terdapat tabel yang menunjukkan outcome

How precise are the prognostic estimates?

Pada penelitian ini beberapa variabel memiliki nilai CI 95% sehingga bermakna

Can I apply this valid, important evidence about prognosis to my

patient?
Is my patient so different to those in the study that the results
cannot apply?
Tidak, pasien dan penelitian ini memiliki kriteria yang sama sehingga
penelitian ini dapat diterapkan prognosisnya

Will this evidence make a clinically important impact on my

conclusions about what to offer to tell my patients?
Ya, karena untuk menentukan suatu keputusan butuh banyak narasumber
sebagai faktor pembantu, dan pasien Thalassemia pada wonosari yang
endemik DHF cukup banyak.

Centre for Evidence-Based Medicine, University of Oxford, 2010