Document Detail

Is there a role for surgery in the acute management of infective endocarditis? A decision analysis and medical claims database approach.
MedLine Citation:
PMID:  3398745     Owner:  NLM     Status:  MEDLINE    
In the absence of good clinical evidence from a randomized trial, the authors performed a decision analysis to determine the potential value of early elective surgery (OPNOW) for patients with left-sided Staphylococcus aureus infective endocarditis. Initial impressions (before performance of decision analysis) and initial runs at the formal models using probability estimates derived from clinicians suggested that OPNOW (i.e., within a few days of starting antibiotics) offered no advantage over attempted medical cure (WAIT) (life expectancy: WAIT = 325 weeks; OPNOW = 255 weeks). Extensive sensitivity analyses identified critical variables that needed further empirical estimation. The Manitoba Health Services Commission database identified 127 incident cases of endocarditis between April 1, 1979, and March 31, 1985, enabling estimation of values for these critical variables. With these estimates, the early surgery strategy appeared much better than the previous analyses had suggested (life expectancy: WAIT = 208 weeks, OPNOW = 256 weeks). The authors believe that this approach of combining decision analysis with medical claims databases is useful as an alternative or precursor to randomized trials, especially where the resource requirements and logistic difficulties of performing randomized trials are great.
H B Abrams; A S Detsky; L L Roos; A Wajda
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Medical decision making : an international journal of the Society for Medical Decision Making     Volume:  8     ISSN:  0272-989X     ISO Abbreviation:  Med Decis Making     Publication Date:    1988 Jul-Sep
Date Detail:
Created Date:  1988-09-08     Completed Date:  1988-09-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8109073     Medline TA:  Med Decis Making     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  165-74     Citation Subset:  IM    
Department of Medicine, University of Toronto, Ontario, Canada.
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MeSH Terms
Decision Trees*
Endocarditis, Bacterial / mortality,  surgery*
Information Systems
Insurance Claim Reporting
Life Expectancy
Medical Records
Staphylococcal Infections / mortality,  surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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