Critical Appraisal

RCT Terapi
Sekenario Klinis
Laki-laki 40 tahun dengan demam 3 hari, kaku kuduk, sakit kepala,
pusing, nyeri menelan, berdasarkan pemeriksaan fisik dan penunjang
pasien didiagnosis dengan Meningitis bakterialis akut.

Apakah pemberian Steroid dapat menurunkan risiko keluaran klinis

yang buruk?
PICO
• P: Adult with acute bacterial meningitis
• I: steroid
• C: placebo
• O: reduce poor outcome
Are the results of this single preventive or
therapeutic trial Valid?
Was the assignment of patients to treatments
randomised?

Was the randomisation list concealed?

Are the results of this single preventive or
therapeutic trial Valid?
Was follow-up of patients sufficiently long
and complete?
Are the results of this single preventive or
therapeutic trial Valid?
Was follow-up of patients
sufficiently long and complete?
Are the results of this single preventive or
therapeutic trial Valid?
Were all patients analysed in Yes
the groups to which they were
randomised?
Are the results of this single preventive or
therapeutic trial Valid?
Were patients and Yes
clinicians kept “blind” to
treatment?

Were the groups treated Yes

equally, apart from the
experimental treatment?
Are the results of this single preventive or
therapeutic trial Valid?
Were the groups similar at
the start of the trial?
 Can you apply this valid, important evidence about
therapy in caring for your patient?
Do these results apply to your patient?
Is your patient so different from those in the No
study that its results cannot apply?
Is the treatment feasible in your setting? Yes
 Can you apply this valid, important evidence about
therapy in caring for your patient?
What are your patient’s potential benefits and harms from the therapy?
Method I: f Risk of the outcome in your patient, relative to
patients in the trial.Expressed as a decimal: 1.5
NNT/f = 10 / 1.5 = 7 (NNT for patients like
yours)
Method II: 1/(PEER x RRR) Your patient’s expected event rate if they received
the control treatment (PEER) = 30%

1/(PEERxRRR) = 1/0.3*0.4 = 8 (NNT for patients

like yours)
 Can you apply this valid, important evidence about
therapy in caring for your patient?
Are your patient’s values and preferences satisfied by the regimen and its consequences?
Do your patient and you have a clear
assessment of their values and preferences?
Are they met by this regimen and its
consequences?