Paeds Cases · professional-practice-and-evidence
Translating an effect estimate into a shared decision — OSCE
OSCE on computing and interpreting measures of effect and applying them to a shared decision with a family.
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Study tools
Target exams
MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
Parents of a 5-year-old with a chronic illness are deciding whether to start a daily preventive therapy; they have read online that it reduces the risk of a serious complication by 50 percent; you have a randomised trial reporting the outcome in 200 of 1,000 controls and 100 of 1,000 treated children, with a 95 percent confidence interval whose lower bound crosses unity in preschool children.
Station brief (8–10 minutes)
Help the parents decide whether to start the preventive therapy by computing the trial's effect honestly and applying it to their five-year-old. Address the online "50 percent" figure, compute the absolute benefit and the number needed to treat from the event rates, read the confidence interval for the preschool subgroup, and weigh applicability to the child. Do not invent jurisdiction-specific thresholds or specific survival statistics. [1]
References6ShowHide
- [1]Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS Evidence based medicine: what it is and what it isn't BMJ, 1996.PMID 8555924
- [2]Laupacis A, Sackett DL, Roberts RS An assessment of clinically useful measures of the consequences of treatment N Engl J Med, 1988.PMID 3374545
- [3]Cook RJ, Sackett DL The number needed to treat: a clinically useful measure of treatment effect BMJ, 1995.PMID 7873954
- [4]Greenhalgh T How to read a paper. Statistics for the non-statistician. II: Significant relations and their pitfalls BMJ, 1997.PMID 9277611
- [5]Altman DG, Bland JM Absence of evidence is not evidence of absence BMJ, 1995.PMID 7647644
- [6]Murad MH, Montori VM, Ioannidis JP, et al. How to read a systematic review and meta-analysis and apply the results to patient care: users' guides to the medical literature JAMA, 2014.PMID 25005654