Risk Factors Indicating the need for cranial CT

scans in erderly patients with head trauma : an

Austrian trial and comparison with the canadian
CT Head Rule

Harald Wolf, M.d.,1 Wolfgang MacHold, M.d.,1 SopHie frantal, M.S.,2 MatHiaS KecHt, M.d.,1 gHolaM
pajenda, M.d.,1 joHanneS leitgeb, M.d.,1 Harald WidHalM, M.d.,1 Stefan Hajdu, M.d., pH.d.,1

Departments of 1Trauma Surgery and 2Medical Statistics, Medical University of Vienna,

Austria

J Neurosurg 120; 447 - 452, 2014

VALIDITAS
• 1. Artikel ini berasal dari peer-reviewed
journal  J Neurosurgery 120
Published Online, Desember, 2013

2. Penelitian ini tidak disponsori oleh

organisasi manapun yang dapat
mempengaruhi desain atau hasil penelitian
dan telah melewati penyaringan etik
3. Bukan penelitian multisenter
 RELEVANSI
4. Penelitian ini dapat diterapkan di pusat
pendidikan kita  metode aplikatif

5. Informasi ini, jika benar, memiliki dampak pada

kesehatan pasien dan pada pembiayaan
ksehatan.

6. Masalah yang dibahas pada jurnal ini umum

ditemukan pada praktek kita dan intervensi
yang diteliti memungkinkan untuk dilakukan
pada praktek kita
MAKSUD PENELITIAN
• Tujuan :
Untuk menilai perlu tidaknya dilakukan
CT Scan kepala pada trauma kepala ringan
GCS 13 – 15 dibandingkan dengan Canadian
CT Head Rule
 Clinical Cathegory
Clinical Description Prefered Study Design
category

Therapy Tests the effectiveness of a Randomized, double-

treatment, such as a drug, surgical blinded, placebo-
procedure, or other intervention controlled trial
Diagnosis Measures the validity (is it Cross-sectional survey
dependable?) and reliability (will (comparing the new
the same results be obtained test with a reference
every time?) of a diagnostic test, standard)
or evaluates the effectiveness of a
test in detecting disease at a
presymptomatic stage when
applied to a large population
Causation Assesses whether sex hormone Cohort or case-control
levels associated with breast
cancer risk
Prognosis Determines the outcome of a Longitudinal cohort
disease study
 Level of Evidence
Level Therapy/Prevention, Prognosis Diagnosis
Aetiology/Harm

1a SR (with homogeneity*) SR (with homogeneity*) SR (with homogeneity*)

of RCTs of inception cohort of Level 1 diagnostic
studies; CDR† studies; CDR† with 1b
validated in different studies from different
populations clinical centres

1b Individual RCT (with Individual inception Validating** cohort study

narrow Confidence cohort study with > with good†††
Interval‡) 80% follow-up; reference standards;
CDR† validated in a or CDR† tested within
single population one clinical centre

1c All or none All or none case-series Absolute SpPins and

SnNouts††
Level Therapy/Prevention, Prognosis Diagnosis
Aetiology/Harm
2a SR (with homogeneity*) SR (with homogeneity*) SR (with homogeneity*) of
of cohort studies of either retrospective Level >2 diagnostic studies
cohort studies or
untreated control
groups in RCTs

2b Individual cohort study Retrospective cohort Exploratory** cohort study

(including low quality study or follow-up of
RCT; e.g., <80% follow- untreated control
up) patients in an RCT;
Derivation of CDR† or
validated on split-
sampleonly
2c "Outcomes" Research; "Outcomes" Research
Ecological studies
with good††† reference
standards; CDR† after
derivation, or validated
only on split-sample or
databases
Level Therapy/Prevention, Prognosis Diagnosis
Aetiology/Harm
3a SR (with homogeneity*) SR (with homogeneity*) of
of case-control studies 3b and better studies
3b Individual Case-Control Non-consecutive study; or
Study without consistently
applied reference
standards
4 Case-series (and poor Case-series (and poor Case-control study, poor or
quality cohort and case- quality prognostic non-independent reference
control studies§) cohort studies***) standard
5 Expert opinion without Expert opinion Expert opinion without
explicit critical appraisal, without explicit critical explicit critical appraisal,
or based on physiology, appraisal, or based on or based on physiology,
bench research or "first physiology, bench bench research or "first
principles" research or "first principles"
principles"
Grades of Recommendation
A consistent level 1 studies

B consistent level 2 or 3 studies or

extrapolations from level 1 studies
C level 4 studies or extrapolations from
level 2 or 3 studies
D level 5 evidence or troublingly
inconsistent or inconclusive studies
of any level