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2011, Number 6

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Rev Med Inst Mex Seguro Soc 2011; 49 (6)

Clinical research VI. The clinical relevance

Talavera JO, Rivas-Ruiz R
Full text How to cite this article

Language: Spanish
References: 6
Page: 631-635
PDF size: 45.54 Kb.


Key words:

Measures of association, exposure, risk or outcome, relative risk.

ABSTRACT

Usually, in clinical practice the maneuver selected is the one that achieve a favorable outcome with a direct percentage of superiority of at least 10 %, or when the number needed to treat ≈ 10. While this percentage difference is practical to estimate the magnitud of an association we need to differentiate the impact measures (attributable risk, preventable fraction), measures of association (RR, OR, HR) and frequency measures (incidence and prevalence), applicable when the outcome is nominal. And we must identify ways to measure the strength of association and the magnitude of the association when the outcome variable is quantitative. It is not uncommon to interpret the measures of association as if they were impact measures. For example, for a RR of 0.68, its common to assume a 32 % reduction of the outcome, but, we must consider that this is a relative reduction, which comes from relation of 0.4/0.6, 0.04/0.06, or 0.00004/0.00006, however the direct reduction is 20 % (60 % - 40 %), 2 %, and 2 per 100 000 respectively. Therefore, to estimate the impact of a maneuver it is important to have the direct difference and / or NNT.


REFERENCES

  1. Cordell WH. Number needed to treat (NNT). Ann Emerg Med 1999;33:433-436.

  2. Feinstein AR. Principles of medical statistics. New York, NY: Chapman and Hall/CRC; 2002.

  3. Guyatt GH, Sackett DL, Cook DJ. Users guides to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help in caring for my patients? Evidence Based Medicine Working Group. JAMA 1994;271:59-63.

  4. KT Clearing House. [Sitio web]. Odds ratio to NNT converter. Disponible en http://ktclearinghouse.ca/cebm/practise/ca/ calculators/ortonnt

  5. Sociedad Española de Hipertensión/Liga Española para la Lucha contra la Hipertensión Arterial. [Sitio web]. Odds ratio, riesgo relativo y número necesario a tratar. Disponible en http://www.seh-lelha.org/oddsratio.htm

  6. University of British Columbia. [Sitio web]. UBC clinical significance calculator. Disponible en http://spph.ubc.ca/ sites/healthcare/files/calc/clinsig.html




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Rev Med Inst Mex Seguro Soc. 2011;49