KELOMPOK :

1. AHMAD SYAIFUL FAESAL

2. RINAIMAH ZAHRA

3. ANDI ZUHRA

4. CITRA DEWILIAH

EVIDENCE BASED MEDICINE

Report : Simulated Clinical Problem

A. General Appraisal

1. Judul : Short Report: Automated Detection of Malaria-

Associated Pseudoeosinophilia and Abnormal WBC

Scattergram by the Sysmex XE-2100 Hematology

Analyzer: A Clinical Study with 1,801 Patients and Real-

Time Quantitative PCR Analysis in Vivax Malaria-

Endemic Area

2. Pengarang : Jong-Ha Yoo, Jaewoo Song, Kyung-A Lee, Young-Kyu

Sun, Young-Ah Kim, Tae Sung Park, Jong Rak Choi

3. Penerbit : The American Society of Trophical Medicine and

Hygiene

4. Tahun : 2010

B. Critical Appraisal

1. Citation
 Short Report: Automated Detection of Malaria-Associated Pseudoeosinophilia and

Abnormal WBC Scattergram by the Sysmex XE-2100 Hematology Analyzer: A

Clinical Study with 1,801 Patients and Real-Time Quantitative PCR Analysis in

Vivax Malaria-Endemic Area

2. Validitas Studi Diagnosis

Apakah terdapat variabel Ya, terdapat variabel independen berupa

independen, perbandingan buta diagnosis penyakit malaria

terhadap gold standar dari diagnosis? Dengan menggunakan gold standar berupa

pemeriksaan apusan darah (pemeiksaan

mikroskopik)

Apakah evaluasi tes diagnosis sesuai Ya, pasien yang diteliti adalah 1801 pasien

dengan spektrum pasien? pada daerah endemik malaria

Apakah standar referensi yang Ya, Studinya sudah direview dan disetujui

digunakan sesuai dengan hasil oleh Research Ethics Board of the National

diagnosis? Health Insurance Corporation at Ilsan

Hospital.

Apakah tes yang digunakan valid, Ya

terdapat grup independen pasien? Ya, terdapat grup pasien malaria sebanyak

413 (276 laki-laki dan 137 wanita)

3. Sample Calculation

Pemeriksaan apusan darah Total

(Gold Standar)

Positif Negatif

WBC Positif 65 4 69

Scattergrams Negatif 348 1384 1732

Total 413 1388 1801

a. Sensitivitas = a/(a+c) = 65/(65+348) = 15.7%

b. Spesifitas = d/(b+d) = 1384/(1384+4) = 99.7%

c. LR + = Sensitivitas/(1-spesifitas) = 15.7% / (1-99.7%) = 52.33

d. LR - = (1-sensitivitas) / spesifitas = (1-15.7%) / 99.7% = 0.84

e. PPV = a/(a+b) = 65/(65+4) = 94.2%

f. MPV = d/(c+d) = 1384/(348+1384) = 79.9%

g. Pre-rest probability (Prevalence) = (a+c) / (a+b+c+d) = (413) / (1801) = 22.9%

h. Pre-test odds = prevalence/(1-prevalence) = 22.9% / 77.1% = 0.29

i. Post-test odds = Pre-test odds x LR+ = 0.29 x 52.33 = 15.17

j. Post-test probability = Post-test odds/(Post-test odds + 1) = 15.17 / 16.17 = 0.93