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To the Editor: In their article on integrating research evidence with the care of the individual patient, Dr McAlister and colleagues¹ state, "Since your radiology department, in a recent audit, demonstrated that their ultrasonographic interpretations are highly correlated with angiographic results,² you feel confident about their findings that both patients have moderate [carotid] stenoses. . . . " This conclusion is not supported by the cited reference, which concludes that "the results indicate that the accuracy of ultrasonography is moderate when flow parameters are used to assess the degree of stenosis. Ultrasonography should be used as a screening tool to exclude patients with no carotid artery disease from further testing. Conventional angiography remains an essential investigation before assigning the risk of stroke and deciding appropriate treatment. . . . "²

By excluding the diagnostic process from the discussion, the authors ignore a basic principle in decision analysis: treatment decisions are . . . [Full Text of this Article]

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RELATED ARTICLE

Users' Guides to the Medical Literature: XX. Integrating Research Evidence With the Care of the Individual Patient
Finlay A. McAlister, Sharon E. Straus, Gordon H. Guyatt, R. Brian Haynes, and for the Evidence-Based Medicine Working Group
JAMA. 2000;283(21):2829-2836.
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