Users' Guides to the Medical Literature

Abstract

YOU RECALL from the first of our two articles concerning clinical decision analysis¹that 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,²and 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