Critical Appraisal

Treatment / Therapeutic intervention

Answerable Clinical Question (ACQ)

P : Patient, Problem, Population

I : Intervention
C : Comparison
O : Outcome

1. Are the results of individual

studies,
valid?
Primary
guides:
1. 1. Was the assignment of patients to treatments randomized? YES

1. 2. Was

follow-up of patients sufficiently long and complete? YES

1. 3. Were patients analyzed in the groups to which they were

randomized? YES

1. Are the results of the study valid?

Secondary guides:

1. 4. Were patients, health workers, and study

personnel "blind" to treatment? yes
(Double Blind)

1. 5. Aside from the experimental intervention, were the

groups treated equally? yes
1. 6. Were the groups similar at the start of the trial? yes
1. 7. Was the randomization concealed? yes

THERAPY WORKSHEET
Are the valid results of this randomized
trial important?
What is the magnitude
of the treatment effect?
How precise is the estimate
of the treatment effect?

2. Are the valid results of individual study,

important?
2. 1. What is magnitude of the treatment effect?
P value, RRR, RRI, ARR, ARI, NNT, NNH

1. Relative Risk Reduction (RRR) :

is the percent reduction in risk in treated group compared to the control group.
RRR
= {(CER EER) / CER}
CER
= Control Event Rate
EER
= Experimental Event Rate
berdasarkan skala Aono :

Propofol terhadap Saline

RRR

= {(CER EER) / CER} (28%-3%)/ 28% = 89,2 %

Propofol menurunkan kejadian agitasi emergensi sebesar 89,2 % dibandingkan

normal saline
Fentanyl terhadap Saline
RRR

= {(CER EER) / CER} (28%-25%)/ 28% = 10,7 %

Fentanyl menurunkan kejadian agitasi emergensi sebesar 10,7 %

dibandingkan normal saline
2. RRI = RRR hasil yang sama

2. 1. What is magnitude of the treatment effect?

3. ARI = Absolute Risk Increase, ABI=

Absolute Benefit Increase, ARR=
Absolute Risk Reduction
ARR=ABI=ARI
Propofol terhadap saline

ARI

= (CER EER) (28%-3%) = 25 %

Fentanyl terhadap Saline

ARI

= (CER EER) (28%-25%) = 3%

2. 1. Elements of magnitude of the

treatment effect
Number Needed to Treat (NNT) = 1 / ARR
* NNT = 1 / 0.25 = 4

we need to treat 4 people with propofol

(rather than normal saline) to prevent one additional person
from emergence agitation

Number
Number Needed
Needed to
to Treat
Treat (NNT)
(NNT) == 11 // ARR
ARR
** NNT
NNT == 11 // 0.03
0.03 == 33
33

we
we need
need to
to treat
treat 33
33 people
people with
with fentanyl
fentanyl
(rather
(rather than
than normal
normal saline)
saline) to
to prevent
prevent one
one additional
additional person
person
from
from emergence
emergence agitation
agitation

THERAPY WORKSHEET

Can you apply this valid, important

evidence about therapy in caring for
your patient?
Do these results apply to our patient?
YES
Is our patient so different
from those in the study that
its results cannot apply?
NO
Is the treatment feasible in our setting?
YES