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May 24, 1995

Users' Guides to the Medical Literature: VII. How to Use a Clinical Decision Analysis B. What Are the Results and Will They Help Me in Caring for My Patients?

Author Affiliations

From the Department of Medicine, University of Rochester (NY) School of Medicine and Dentistry (Dr Richardson), and the Departments of Health Administration and Medicine, University of Toronto (Ontario), and the Division of General Internal Medicine and Clinical Epidemiology, The Toronto (Ontario) Hospital (Dr Detsky).

JAMA. 1995;273(20):1610-1613. doi:10.1001/jama.1995.03520440064038

YOU RECALL from the first of our two articles concerning clinical decision analysis1 that your patient is a middle-aged man with heart failure from an idiopathic dilated cardiomyopathy. You are trying to decide whether to recommend anticoagulation with warfarin to prevent systemic or pulmonary thromboembolism. Your literature search showed that no randomized clinical trials of warfarin for this use have been published. The search did discover a clinical decision analysis,2 and in the first article, we showed you how to evaluate its validity. In this article, we will show you how to interpret the results and generalizability of a clinical decision analysis (Table).

As shown in the Figure, decision trees are displayed graphically, oriented from left to right, with the decision to be analyzed on the left, the compared strategies in the center, and the clinical outcomes on the right. The square box, termed a "decision node," represents