Question
Researchers evaluated the effectiveness of a single application of topical chloramphenicol ointment in preventing wound infection after minor dermatological surgery.They conducted a placebo controlled double blind multicentre trial. Control treatment was a single application of paraffin ointment. In total, 448 minor surgery patients were allocated to chloramphenicol and 484 to placebo.
The primary outcome was incidence of infection within 30 days of the minor skin excision. The incidence of infection in the chloramphenicol group was 6.6% compared with 11.0% in the control group (P=0.010). The absolute reduction in infection rate was 4.4%, whereas the relative risk of wound infection in the control group compared with the intervention group was 1.7 (95% confidence interval 1.1 to 2.5). The number needed to treat for topical chloramphenicol ointment compared with control treatment was 23.
Which one of the following statements best describes number needed to treat for the comparison of topical chloramphenicol ointment with control treatment?
·a) Treatment of 23 patients with control will result in one less infection.
·b) Treatment of 23 patients with chloramphenicol will result in one infection.
·c) Treatment of 23 patients with chloramphenicol will result in one less infection.
·d) Treatment of 23 patients with chloramphenicol will result in one less infection than if they had received the control treatment.
·e) Patients in the control group were 23 times more likely to have an infection compared with those in the chloramphenicol group.
提示：正确答案只有一个。
Answer
Answer d is the best description. The incidence of infection within 30 days of the minor skin excision was lower for the topical chloramphenicol ointment group than for the control group. Number needed to treat summarises this treatment effect, it being a measure of the benefit of treatment with chloramphenicol compared with control. The number needed to treat is the number of participants who need to be treated with chloramphenicol for one less patient to experience an infection (benefit from the intervention) than if they had received the control treatment.
Answer c is a common misinterpretation of the number needed to treat; that is, the number of patients who need to be treated with chloramphenicol to prevent one infection or for one person to benefit. As a measure of the therapeutic benefit of treatment, number needed to treat compares the effectiveness of treatment with chloramphenicol to that of the control.
The importance of the magnitude of the number needed to treat is a clinical decision. Nonetheless, the smaller the value of the number needed to treat, the greater the therapeutic benefit of the intervention compared with control. The therapeutic benefits of topical chloramphenicol ointment as measured by the number needed to treat must be assessed alongside other measures of risk, including the absolute risks of infection in each treatment group, absolute risk reduction, and relative risk of infection for control compared with chloramphenicol. Next week’s question will consider the calculation of number needed to treat.
所以答案是选择 d
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