Aplicación del sistema GRADE a las recomendaciones de pruebas diagnósticas en la Guía Colombiana de Falla Cardíaca

Juan Manuel Senior, Edison Muñoz-Ortiz, James Samir Díaz-Betancur

Resumen


Introducción: el ejercicio clínico trae implícito un grado de incertidumbre en cuanto al diagnóstico preciso, en relación con un cúmulo de síntomas y signos en el contexto de los factores de riesgo predisponentes detectados al hacer una historia clínica cuidadosa y completa. Se requiere entonces que los clínicos estén familiarizados con las propiedades de las pruebas diagnósticas para utilizarlas en forma adecuada y no como una pesquisa infructuosa y poco específica.

Metodología: llevamos a cabo una revisión de las características operativas de las pruebas diagnósticas, incluyendo sensibilidad, especificidad, valores predictivos positivo y negativo, cocientes de verosimilitud (LR, por su sigla en inglés) positivo y negativo y curvas ROC, los cuales funcionan como base para establecer las recomendaciones de las pruebas diagnósticas en el sistema GRADE en la Guía Colombiana de Falla Cardíaca.

Resultados: explicamos cómo hacer la calificación de las pruebas diagnósticas con la metodología GRADE, teniendo en cuenta las características operativas de las pruebas, y las variables que influyen en la graduación de las recomendaciones, tales como el riesgo de sesgos, el carácter directo o no de la prueba, la presencia de inconsistencia o imprecisión y el sesgo de publicación.

Conclusión: la metodología GRADE de calificación de la evidencia en las pruebas diagnósticas permite una valoración completa de estas, tanto en sus características operativas como de aplicación en la práctica clínica.


Palabras clave


Diagnóstico; Guía; Insuficiencia Cardíaca

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Referencias


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