scholarly journals Biostatistics in Clinical Decision Making What can We Get from a 2×2 Contingency Table

2021 ◽  
Vol 233 ◽  
pp. 02014
Author(s):  
Shanshan Zhang
Keyword(s):  
Prospective Studies ◽  
Clinical Decision Making ◽  
Contingency Tables ◽  
Roc Curves ◽  
Clinical Decision ◽  
Chi Square ◽  
Predictive Values ◽  
Duodenal Diverticula ◽  
Chi Square Test ◽  
Relationship Of

Biostatistics is an essential part when making clinical decisions. Applications of 2×2 contingency tables playing a key role in conducting analysis involving binary variables. When it comes to analysis based on 2×2 contingency tables, most people are familiar with the concept of sensitivity and specificity for evaluating a new test, but predictive values and receiver operating characteristic (ROC) curves would also provide information. Besides, Odds Ratio (OR), Risk Ratio (RR), and Chi-square test are measures based on 2×2 tables and commonly applied in retrospective and prospective studies. This article will first review the two kinds of application of 2×2 contingency tables, evaluating a new test compared with a reference standard, and exploring the relationship of exposures and outcomes in retrospective or prospective studies. Two clinical examples are presented to demonstrate these basic biostatistical concepts: diagnostic accuracy of 64-slice multidetector computed tomography (64-MDCT) to identify periampullary duodenal diverticula, and a randomized clinical trial (RCT) to examine the effectiveness of Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery. Correctly understanding these concepts will assist clinicians and medical researchers to analyze the data and interpret the results, and therefore make accurate decisions in clinical practice.

scholarly journals Influenza With and Without Fever: Clinical Predictors and Impact on Outcomes in Patients Requiring Hospitalization

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
Benjamin J Smith ◽  
David J Price ◽  
Douglas Johnson ◽  
Bruce Garbutt ◽  
Michelle Thompson ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Antiviral Treatment ◽  
Delayed Diagnosis ◽  
Clinical Decision ◽  
Case Definition ◽  
Influenza B ◽  
Clinical Predictors ◽  
Chi Square ◽  
Chi Square Test ◽  
The Impact

Abstract Background The Infectious Diseases Society of America influenza guidelines no longer require fever as part of their influenza case definition in patients requiring hospitalization. However, the impact of fever or lack of fever on clinical decision-making and patient outcomes has not been studied. Methods We conducted a retrospective review of adult patients admitted to our tertiary health service between April 2016 and June 2019 with laboratory-confirmed influenza, with and without fever (≥37.8ºC). Patient demographics, presenting features, and outcomes were analyzed using Pearson’s chi-square test, the Wilcoxon rank-sum test, and logistic regression. Results Of 578 influenza inpatients, 219 (37.9%) had no fever at presentation. Fever was less likely in individuals with a nonrespiratory syndrome (adjusted odds ratio [aOR], 0.44; 95% CI, 0.26–0.77), symptoms for ≥3 days (aOR, 0.53; 95% CI, 0.36–0.78), influenza B infection (aOR, 0.45; 95% CI, 0.29–0.70), chronic lung disease (aOR, 0.55; 95% CI, 0.37–0.81), age ≥65 (aOR, 0.36; 95% CI, 0.23–0.54), and female sex (aOR, 0.69; 95% CI, 0.48–0.99). Patients without fever had lower rates of testing for influenza in the emergency department (64.8% vs 77.2%; P = .002) and longer inpatient stays (median, 2.4 vs 1.9 days; P = .015). These patients were less likely to receive antiviral treatment (55.7% vs 65.6%; P = .024) and more likely die in the hospital (3.2% vs 0.6%; P = .031), and these differences persisted after adjustment for potential confounders. Conclusions Absence of fever in influenza is associated with delayed diagnosis, longer length of stay, and higher mortality.

Abstract W MP61: Prevalence of Echocardiographic Abnormalities in Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Bryan Eckerle ◽  
Heidi Sucharew ◽  
Kathleen Alwell ◽  
Charles J Moomaw ◽  
Matthew Flaherty ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Decision Making ◽  
Retrospective Chart Review ◽  
Clinical Decision ◽  
Imaging Method ◽  
Chi Square ◽  
Exact Test ◽  
High Prevalence ◽  
Chi Square Test

Introduction: Non-invasive cardiac imaging is an important tool in evaluation of acute ischemic stroke, as a cardiac source can be implicated in approximately 20% of cases. However, the preferred imaging method is unclear due in part to the lack of consistent data regarding the yield of the two most commonly employed modalities, transthoracic and transesophageal echocardiography (TTE and TEE). Here we examine, in a large, biracial population, the prevalence of abnormalities detected by echocardiography during evaluation of acute ischemic stroke. Methods: Acute ischemic stroke cases were identified from a population of 1.3 million in the Greater Cincinnati area in 2005. Medical history and echocardiography results were determined by retrospective chart review. Echocardiographic abnormalities were pre-defined based on possibility of change in clinical decision making. All cases were abstracted by study nurses and subsequently verified by study physicians. Results were stratified by cardiac history and choice of echocardiographic technique; groups were compared using chi-square test or Fisher’s Exact test. Results: There were 2197 hospital-ascertained ischemic stroke cases in 2005. Median age was 73 (IQR 61-81), 22% were black, and 55% were female. TTE was performed in 68% of cases; TEE was performed in 7%. TEE revealed at least one abnormality in 55% of cases with cardiac history and 32% of cases without (Table). Yield of TTE was 20% in cases with cardiac history and 3% in cases without. Discussion: TEE is of considerable yield in selected patients, irrespective of cardiac history. This is in keeping with prior cost-effectiveness analyses recommending TEE alone for patients in whom suspicion of occult source of cardiac embolism is high. Prevalence of abnormalities on TTE in this population is similar to that of previously published series.

scholarly journals 1331. Interpretation and Application of Rapid Diagnostic Methodologies: The Positive Impact of Online, Curriculum-Based Learning

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S481-S481
Author(s):  
Simi Thomas. Hurst ◽  
James Martorano ◽  
Catherine Capparelli
Keyword(s):  
Online Education ◽  
Clinical Decision Making ◽  
Positive Impact ◽  
Clinical Decision ◽  
Antibiotic Use ◽  
Considerable Effect ◽  
Chi Square ◽  
Noticeable Effect ◽  
Chi Square Test ◽  
Post Assessment

Abstract Background Antibiotic resistance has become one of the most serious public health threats today. Used appropriately, newer rapid diagnostic methodologies have the potential to positively impact care by informing a more targeted treatment approach that can reduce inappropriate antibiotic use, support antimicrobial stewardship, shorten hospital stays, and improve clinical outcomes. Methods To improve ID specialists’ knowledge and application of rapid diagnostic tests, a CME/ABIM MOC/ACCENT certified curriculum was developed. The curriculum comprised a series of 4 educational episodes, each with a video commentary from a clinical expert and each focused on a different site of infection: (a) Episode 1: CNS; (b) Episode 2: Gastrointestinal tract; (c) Episode 3: Respiratory tract; and (d) Episode 4: Bloodstream. The episodes in the curriculum were launched in serial fashion between October 30, 2018 and February 11, 2019, on a website dedicated to continuous professional development. Educational effectiveness was assessed with a repeated-pairs pre-/post-assessment study design; each individual served as his/her own control. A chi-square test assessed changes pre- to post-assessment. P values of < 0.05 are statistically significant. Effect sizes were evaluated using Cramer’s V (<0.05 modest; 0.06–0.15 noticeable effect; 0.16–0.26 considerable effect; >0.26 extensive effect). Results 15,092 HCPs, including 10,894 physicians have participated in the curriculum. This initial analysis comprises data from the subset of ID specialists from each episode who answered all pre-/post-assessment questions through March 18, 2019; data collection is ongoing. Following participation, significant improvements were observed overall (P ≤ 0.002 for each episode) and on the specific topics assessed in each episode (Graph). Additionally, 51%–55% of ID specialists indicated an intent to modify their diagnostic approach and 15%–29% had increased confidence in applying the rapid diagnostic results into patient care. Conclusion This educational curriculum significantly improved ID specialists’ knowledge of the strengths and limitations of different rapid diagnostic methodologies and improved the applications of test findings into clinical decision-making. These findings highlight the positive impact of well-designed online education. Disclosures All authors: No reported disclosures.

Usia Resiko Tinggi dan Perdarahan Post Partum

2018 ◽  
Vol 3 (2) ◽  
pp. 91
Author(s):  
Ani Media Harumi ◽  
Kasiati Kasiati
Keyword(s):  
High Risk ◽  
Post Partum ◽  
Chi Square ◽  
Sample Number ◽  
Chi Square Test ◽  
Study Population ◽  
Relationship Of ◽  
The Relationship

Abstract: The purpose of this study is to analyze the relationship of age high risk with the incidence ofbleeding post partum in dr. M. Soewandhie Surabaya hospital. This research is analytic with an approachof a sectional cross. The study population was all post partum mothers in the Dr. M. Soewandhie Surabayahospital in January 2016 to March 2017, which amounts to an average of 1840respondents while theresearch sample number 182. Measuring collection sheet data obtained by systematic random sampling.The Study was conducted Chi-Square test obtained mean count X2 (0,00) is less than á (0.05) thenH0 is rejected and H1 accepted it means that there is a relationship between the age of high risk withbleeding post partum. Conclusion, there is a relationship between the age of high risk with the incidenceof bleeding post partum in the Spaceof the Maternity room Dr. Moch. Soewandhie Surabayahospital.

scholarly journals Simultaneous Use of Two Different Tools to Assess Compliance with Antiepileptic Drugs: Experience in A Community-Based Study

2020 ◽  
Vol 11 (04) ◽  
pp. 636-639
Author(s):  
Paramjit Singh ◽  
Kanchan Gupta ◽  
Gagandeep Singh ◽  
Sandeep Kaushal
Keyword(s):  
Head Injuries ◽  
Emergency Department Visits ◽  
Pill Count ◽  
Self Report ◽  
Chi Square ◽  
Breakthrough Seizure ◽  
Adherence Scale ◽  
Pill Counts ◽  
Chi Square Test ◽  
Relationship Of

Abstract Objective Antiepileptic drug (AED) therapy remains the primary form of treatment for epilepsy, noncompliance to which can result in breakthrough seizure, emergency department visits, fractures, head injuries, and increased mortality. Various tools like self-report measures, pill-counts, medication refills, and frequency of seizures can assess compliance with varying extent. Thus, assessment of compliance with AEDs is crucial to be studied. Materials and Methods Compliance was assessed using pill-count and Morisky medication adherence scale (MMAS) during home visits. A pill-count (pills dispensed–pills remaining)/(pills to be consumed between two visits) value of 0.85 to ≤1.15 was recorded as appropriate compliance. Underdose (<0.85) and overdose (>1.15) was labeled as noncompliance. Score of 1 was given to each positive answer in MMAS. Score of ≥1 was labeled as noncompliance.Statistical analysis: Relationship of demographic factors between compliant and noncompliant patients was analyzed using Chi-square test (SPSS version 21.0, IBM). Rest of the data was analyzed with the help of descriptive statistics using Microsoft Excel. p< 0.05 was considered statistically significant. Results Out of 105 patients, 54 patients were noncompliant with both pill-count and MMAS. 10 patients were noncompliant with pill-count only, while 10 were noncompliant with MMAS. Conclusion Both tools complement each other when used in combination, as use of a single tool was not able to completely detect compliance.

scholarly journals The Role of Anemia in Pregnancy in the Incidence of Post Partum Hemorrhage in Maternal Maternity at the Hospital in Sidoarjo, Indonesia

2019 ◽  
Vol 2 ◽  
Author(s):  
Mukarromatul Khoiroh ◽  
Nurul Azizah
Keyword(s):  
Postpartum Hemorrhage ◽  
Post Partum ◽  
Sampling Technique ◽  
Simple Random Sampling ◽  
Chi Square ◽  
Chi Square Test ◽  
Anemia In Pregnancy ◽  
Relationship Of ◽  
The Relationship ◽  
In Pregnancy

Postpartum hemorrhage is bleeding that occurs after the birth of the baby, placenta, and 2 hours after the placenta is born. One of the causes is anemia. Research in 2015, 60% of 100 mothers giving birth at RSIA Kirana Taman Sidoarjo experienced postpartum hemorrhage. The aim of the study was to determine the relationship of anemia in pregnancy with the incidence of postpartum hemorrhage in labor mothers. The study design used an analytical survey with a retrospective method. The population of 206 maternity mothers was taken with simple random sampling technique as many as 136 samples in August 2017. Data were analyzed by Chi Square statistical test with 0.05. The results showed that postpartum hemorrhage was more experienced by mothers with anemia (66.7%) than  those without anemia (26.2%). While those who did not experience postpartum hemorrhage were more experienced by mothers who were not anemic (73.8%) than those who were anemic (33.3%). Chi square test results  (p=0.000  <0.05),  which means there is a relationship  of anemia in pregnancy with the incidence of postpartum hemorrhage in labor mothers. Conclusions of the study were the relationship of anemia in pregnancy with the  incidence  of postpartum hemorrhage in labor mothers. It is expected that midwives and doctors conduct early detection of anemia so that appropriate care can be carried out.

scholarly journals Evaluation and management of blunt injury abdomen based on focussed assessment with sonography in trauma

2020 ◽  
Vol 9 (1) ◽  
pp. 61
Author(s):  
Sameer Ahmed
Keyword(s):  
Computed Tomography ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Blunt Injury ◽  
Predictive Values ◽  
Bedside Test ◽  
Intraabdominal Injuries ◽  
Low Sensitivity

Background: The initial evaluation of patient with multiple trauma is a challenging task. FAST (focussed assessment with sonography in trauma) provides a viable alternative to computed tomography in blunt abdominal trauma patient. The aim of this study was to find the accuracy and utility of FAST in clinical decision making, as well as limitations.Methods: A total of 100 patients with blunt abdominal trauma who underwent FAST examination were included. Positive scan was defined as the presence of free intraperitoneal fluid. The sonographic scoring for operating room triage in trauma (SSORTT Score) was calculated using cumulative sum of ultrasound score, systolic blood pressure, and pulse rate. FAST findings were compared with computed tomography findings and in operated cases compared with surgical findings & clinical outcome.Results: We determined SSORTT score in all 100 cases. In our study, the sensitivity, specificity, positive and negative predictive values for FAST in identifying intraabdominal injuries were 93.9%, 94.2%, 87.5%, and 97.2%. In our study we found out that patients with a SSORTT score of 2 and above had a high likelihood of requiring a therapeutic laparotomy.Conclusions: In our study we found that FAST is a rapid, reproducible, portable and non-invasive bedside test, and can be performed at the same time as resuscitation. Ultrasound is limited mainly by its low sensitivity in directly demonstrating solid organs injuries.

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