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OUTPUT : APPRAISING AN ARTICLE

Group 10A
Acuna
I.

Article search

Figure 1. PubMed page showing advance options for searching.

Figure 2. Results of PubMed search engine using the keywords.

Figure 3. Preview of the article on PubMed.

II.

Appraisal of the Article

I.
Evaluating Directness
1. Does the study provide a
direct enough answer to your
clinical question in terms of
patient (P), Examination (E)
used and disease or outcome
(O) being diagnosed?

II.
Appraising Validity
1. Was the reference standard
an acceptable one?

Yes, because the patients chosen were all


positive for subarachnoid hemorrhage
using computed tomography (CT) scan
which is the gold standard for detecting
subarachnoid (SA) hemorrhage, lumbar
puncture or both. An exclusion criterion
was also stated in the study (admission to
the neurosurgical units more than 96
hours after subarachnoid hemorrhage)
along with its objective which is to reduce
infarction and poor outcomes of SA
hemorrhage using nimodipine. The study
also
used
prospective,
multicentre,
randomised,
double
blind,
placebo
controlled trial as its design. The placebo
was its intervention with whom the
nimodipine will be compared to as to
efficacy.

It was acceptable because CT was the


gold
standard
for
detecting
SA
hemorrhage.
But for patients having
negative result for CT, using lumbar
puncture (LP) can be disregarded now and
instead be replaced by CT angiography
(CTA) which is more sensitive and noninvasive procedure.
2. Was the reference standard Yes, according to p.636 of the journal
interpreted
independently (Double
blind,
placebo
controlled,
from the test question?
randomised trial with three months of
follow up and intention to treat analysis.
To have an 80% chance with a
significance level of 0-05 of detecting a
50% reduction in an incidence of cerebral
infarction of 15% a minimum of 540
patients was required.), there is double
blinding in the study. Placebo or
nimodipine 60 mg was given orally every
four hours for 21 days to 276 and 278
patients, respectively. Treatment was
started
within
96
hours
after

subarachnoid haemorrhage.
III.
Interpreting Results
1. How large was the effect of
the treatment?
2. How precise was the estimate
of the treatment effect?

According to p.636 (22% (61/278)


compared with 33% (92/276) in those
given placebo, a significant reduction of
34% (95% confidence interval 13 to 50%).
Poor outcomes
were also significantly reduced by 40%
(95% confidence interval 20 to 55%) with
nimodipine (20% (55/278) in patients
given nimodipine v 33% (91/278) in those
given placebo).
Cerebral Infarction:
ARR = .33 - .22 = .11
RR = .22/.33 = 0.666667
RR < 1
RRR = .11/.33 = 0.333333
RRR > 0%
Poor Outcomes:
ARR = .33 - .20 = .12
RR = .20/.33 = 0.606061
RR < 1
RRR = .12/.33 = 0.363636
RRR > 0%
The results above shows that nimodipine
is beneficial for the patients. It lowered
the risk of cerebral infarction up to 34%
and 40% reduction on poor outcomes.

IV.
Assessing Applicability
1. Are there biologic issues that
may affect applicability of
treatment?
2. Are
there
socio-economic
issues affecting applicability
of treatment?
V.
Individualization of the
Results
1. Are the likely treatment
benefits worth the potential
harm and costs?

There were no biologic and socioeconomic issues that may affect the
applicability of the treatment.

Cerebral Infarction
NNT = 100/ARR
= 100/.11 = 909.0909
You need 909 patients with risk for SA
hemorrhage to prevent 1 patient from
having cerebral infarction.

Poor Outcomes
NNT = 100/ARR
=100/.12 = 833.3333
You need to treat 833 patients with SA
hemorrhage to prevent 1 poor outcome.

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