Professional Documents
Culture Documents
ON PROGNOSIS
DEDDY NW ACHADIONO
CLINICAL SCENARIO
• Man with a history of a stroke who is concerned
about his risk of seizure
Are the results of this study valid?
• Information about prognosis can come from a variety of
study types.
• Cohort studies are the best source of evidence about prognosis.
• Randomised control trials can also provide information about
prognosis although trial participants may not be representative of
the population with the disorder.
• Case-control studies are useful when the outcome of interest is
rare or when the required follow-up is long. The strength of
inference that can be drawn from a case-control study is limited.
• You see a 70 year old man in your outpatient clinic 3 months after he
was discharged from your service with an ischemic stroke.
• He is in sinus rhythm, has mild residual left-sided weakness but is
otherwise well.
• His only medication is ASA and he has no allergies.
• He recently saw an article on the BMJ website describing the risk of
seizure after a stroke and is concerned that this will happen to him.
• Our search of the literature to answer this question retrieved an
article from the BMJ (1997;315:1582-7).
Was a defined, representative sample of patients assembled at a
common (usually early) point in the course of their disease?
• And 'p' is a proportion of people with the outcome of interest and 'n'
is the sample size.
From the study, n = 675 and p = 0.057
SE =
= 0.009
Therefore the 95% CI is:
0.057 +/- 1.96 x 0.009 = 3.9% to 7.5%
Child Health
Are children with middle ear disease at increased risk
of behavioural problems? Arch Dis Child 1999;80:28-35.
Critical Care Medicine
In patients without motor response three days after hypoxic
stroke, what is the probability of a good neurologic recovery
(cerebral performance category[CPC] 1 or 2)? Edgren E,
Hedstrand U, Sutton-Tyrell K, Safar P, and BRCTI stud
group. Assessment of neurological prognosis in comatose
Gastroenterology and Hepatology
In a patient with newly diagnosed Crohn's disease what are the chances of
dying prematurely? Loftus EV, Silverstein MD, Sandborn WJ, et al.
Crohn's Disease in Olmstead County Minnesota, 1940-1993:
Incidence, Prevalence, and Survival. Gastroenterology
1998;114:1161-1168.
General Practice
What is the risk of recurrence of ureteric calculus after a single episode in a
middle aged male?Kamihira O, et al. Long-term stone recurrence rate
after extracorporeal shock wave lithotripsy. J Urol 1996
Oct;156(4):1267-71.
Alhamdulillah