1. EXPLORACION BASADA EN LA EVIDENCIA

14. LR + (LIKELIHOOD RATIO DEL VALOR POSITIVO) LR + = [VP/ (VP + FN)] / [FP/ (FP+VN)] LR + = SENSIBILIDAD / (1- ESPECIFICIDAD)

15. LR - = LIKELIHOOD NEGATIVO LR - = [FN / (VP + FN)] / [ VN / (FP + VN)] LR - = ( 1 – SENSIBILIDAD) / ESPECIFICIDAD

16. LR: Impact on Likelihood of Disease LR = 0.01 Less Likely LR = 100 More Likely LR = 0.1 Less Likely LR = 10 More Likely LR = 0.2 Less Likely LR = 5 More Likely LR = 0.3 Less Likely LR = 3 More Likely  0 increasing impact Increasing impact LR = 1 No Impact on Likelihood of Disease

19. Does This Adult Patient Have Acute Meningitis?

20. Case Scenario 1 30-year-old man presents to emergency department (ED) 24-hour history of chills and a stiff neck Afebrile with normal mental status Full neck flexion but with cervical pain Kernig and Brudzinski signs absent

21. LR: Impact on Likelihood of Disease LR = 0.01 Less Likely LR = 100 More Likely LR = 0.1 Less Likely LR = 10 More Likely LR = 0.2 Less Likely LR = 5 More Likely LR = 0.3 Less Likely LR = 3 More Likely  0 increasing impact Increasing impact LR = 1 No Impact on Likelihood of Disease

22. Test Characteristics: Examination Likelihood Ratios From Prospective Studies

23. Likelihood Ratio Jolt accentuation test LR– = 0.05 If negative, posttest probability < 0.1% Jolt accentuation test LR+ = 2.4 1% Pretest probability in population presenting to ED If positive, posttest probability = 2%

41. Caso I Paciente de 33 años, mujer, Cefalea holocraneal Características del dolor: no bien definido Fotofobia Fonofobia Náuseas Empeora con el esfuerzo físico

44. Caso II Paciente mujer de 42 años, que mientras practica carrera de fondo siente dolor súbito frontoparietal muy intenso desde el inicio. No refiere antecedentes personales ni familiares de interés. Consciente en todo momento con sensación de dolor grave.

47. Caso III Cefalea crónica diaria Mujer de 52 años Abuso de analgésicos Debuta con diplopid y afasia.

52. NO OLVIDEN LIKELIHOOD RATIO