Step 3:

Critically
Appraising
the Evidence:
Statistics for
 Table of Contents
Clinical Statistics Calculator (Excel
)
Statistics for:
Therapy
Control Event Rate (CER) & Experimental E
vent Rate (EER)
Number Needed to Treat (NNT)
Absolute Risk Reduction (ARR)
Relative Risk (RR)
Odds
Odds Ratio (OR)
Practice Exercises
 Making It Easier
If available, find the best
evidence in secondary sources
where analysis has already
occurred.
If not pre-assessed, use critical
appraisal worksheets to help
you through the process.
 Importance of Critically
Appraising the Evidence
Understanding the Limitations of
the Authors Analyses and
Interpretations of the Data
Assessing Internal Validity
Assessing External Validity
Identifying Potential
Confounding Variables
Simpsons Paradox
Critical Appraisal
Basics
View movie
as:
QuickTime (
.mov)
Flash (.swf)

Double-click on video for full-

screen mode.
 Generalized 2x2
Clinical Table
Target Outcome
+ -
+ a (True b (False
Positiv Positiv
Interventio es) es)
n/
- c (False d (True
Comparison
Negativ Negati
es) ves)
 Control Event Rate (CER)
and
Experimental Event Rate
Experimental(EER)
Event Rate (EER)
The proportion of patients (in the
intervention) who experienced the
target disorder with the treatment
Control Event Rate (CER)
The proportion of patients (in the
comparison group) who experienced
the target disorder without the
treatment
 Calculating CER and
EER
Experimental Event Rate (EER)
a/(a+b)

Control Event Rate (CER)

c/(c+d)
 Number Needed to
Treat (NNT)
The estimated number of
patients needed to be treated
for every patient benefiting
from the treatment beyond
baseline/control expectation
So small numbers indicate
greater effectiveness
 Calculating NNT:
Starting Off
Essentially we want to know how
many patients we must treat before
we can expect one successful
treatment beyond what we would
normally expect without treatment.
First consider, what we already know:
We know both the proportions of how
many patients still had the target
disorder that were treated (EER) and that
were not treated (CER).
 Calculating NNT:
Establish Baseline
With these two proportions we can
find the proportion of successful
treatment beyond the baseline
expectation (control).
From there, we can determine how
many we would need to treat to
expect one success.
Now lets start from the baseline:
Find the proportion of untreated
patients with the target disorder (CER
).
 Calculating NNT:
Calculating
Absolute Risk Reduction
Now we want(ARR)
to know how much
better the treatment did than no
treatment at all. So we find the
proportion of the treated patients
that had the target disorder (EER)
Now we find their difference
(CER-EER), which we call the
Absolute Risk Reduction (ARR).
 Calculating NNT: ARR
Example
That is if 10% of the untreated patients
had the disease and 3% of the treated
patients had the disease, then the
treatment helped 7% (=10%-3%) of the
treated patients (which if left without
treatment would still likely have the
disease). So 0.07 would be the ARR.
Hence ARR is the probability that
treatment will reduce the risk of a given
patient beyond baseline expectation.
 Calculating NNT: Using
the ARR
Now we know that the treatment reduced
the risk of a proportion of patients, which
we call Absolute Risk Reduction and that
ARR = CER EER.
In other words, ARR is the number of
successful treatments beyond baseline
expectation divided by the number of
treated patients.
Now were close. NNT is the number of
treated patients per successful treatments
beyond baseline expectation. Can you see
the relationship yet?
 Calculating NNT:
Another way of looking at
it
In this situation, we should look for a
way to invert our number.
We know that we can divide any number
by 1 without altering it. So ARR =
ARR/1. So think of ARR as a fraction.
Now think of the number of successful
treatments beyond baseline expectation
as the unit on top of the fraction (i.e.
ARR) and the number of treated
patients as the unit on the bottom.
 Calculating NNT: Final
Touches
Now if we take the inverse (i.e. flip
our fraction over) and calculate
1/ARR, we get a number where the
units are flipped. Thereby, this
number has the number of treated
patients as the unit on top of the
fraction (i.e. ARR) and the number
of successful treatments beyond
baseline expectation as the unit on
the bottom. This is exactly how we
defined NNT.
 Calculating NNT: The
Formula
NNT = 1/ARR = 1/|CER EER|
Often rounded up to nearest
whole number
NNT Question
View movie
as:
QuickTime
(.mov)
Flash (.swf)

Double-click on video for full-

screen mode.
Answer to NNT
Question
View movie
as:
QuickTime
(.mov)
Flash (.swf)

Double-click on video for full-

screen mode.
 Relative Risk (RR)
The number of treated/exposed
patients with the target outcome
for every patients in the control
with the target outcome
(Also used in therapy articles)

RR = EER / CER
= (a/(a+b)) / (c/(c+d))
Relative Risk Video
View movie
as:
QuickTime
(.mov)
Flash (.swf)

Double-click on video for full-

screen mode.
 Odds
The number of times the
target outcome occurred in
patients exposed to the risk
for each time the target
outcome occurred in patients
not exposed to the risk.
 Odds Ratio (OR)
OR = (a/b) / (c/d)
= a*d / b*c

A measure of association
When large, there is greater
association
 Try it on your own.
Critical Appraisal Practice
Exercises
From CEBM
 Links to Other Websites
and Hands-On Activities
EBM Glossary
From CEBM
Critical Appraisal Practice
Exercises
From CEBM
Congratulation
s!
You have
successfully
completed
Step 3.
The End