Release 5 Preview #1
Clinical ReasoningThis page is part of the FHIR Specification (v4.2.0: R5 Preview #1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
| Clinical Decision Support Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: Not linked to any defined compartments |
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Corticosteroids vs No corticosteroids for Patients with Sepsis with Mortality (60 days to 1 year)
{
"resourceType": "Evidence",
"id": "example",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: example</p><p><b>title</b>: Corticosteroids vs No corticosteroids for Patients with Sepsis with Mortality (60 days to 1 year)</p><p><b>status</b>: draft</p><p><b>relatedArtifact</b>: </p><p><b>description</b>: Mortality reduced with RR 0.94 with Corticosteroids vs no corticosteroids for patients with sepsis</p><h3>ReferentGroups</h3><table><tr><td>-</td><td><b>Description</b></td><td><b>EvidenceSource</b></td><td><b>IntendedGroup</b></td><td><b>DirectnessMatch</b></td></tr><tr><td>*</td><td>Patients with sepsis</td><td>???</td><td>Patients with sepsis</td><td>??? <span>(Details : {http://terminology.hl7.org/CodeSystem/directness code 'null' = 'null', given as '???'})</span></td></tr></table><blockquote><p><b>variableDefinition</b></p><p><b>description</b>: Mortality Longer term (60 days to 1 year)</p><p><b>variableRole</b>: measured variable <span>(Details : {http://terminology.hl7.org/CodeSystem/variable-role code 'measuredVariable' = 'measured variable', given as 'measured variable'})</span></p><p><b>actualDefinition</b>: many studies had shorter term outcomes</p><p><b>intendedDefinition</b>: Mortality Longer term (Follow up: 60 days to 1 year)</p><p><b>directnessMatch</b>: moderate <span>(Details : {http://terminology.hl7.org/CodeSystem/directness code 'moderate' = 'Moderate quality match', given as 'moderate'})</span></p></blockquote><blockquote><p><b>variableDefinition</b></p><p><b>description</b>: Corticosteroids</p><p><b>variableRole</b>: exposure <span>(Details : {http://terminology.hl7.org/CodeSystem/variable-role code 'exposure' = 'exposure', given as 'exposure'})</span></p><p><b>actualDefinition</b>: ???</p><p><b>intendedDefinition</b>: Corticosteroids</p><p><b>directnessMatch</b>: ??? <span>(Details : {http://terminology.hl7.org/CodeSystem/directness code 'null' = 'null', given as '???'})</span></p></blockquote><blockquote><p><b>variableDefinition</b></p><p><b>description</b>: No corticosteroids</p><p><b>variableRole</b>: referenceExposure <span>(Details : {http://terminology.hl7.org/CodeSystem/variable-role code 'referenceExposure' = 'reference exposure', given as 'referenceExposure'})</span></p><p><b>actualDefinition</b>: ???</p><p><b>intendedDefinition</b>: No corticosteroids</p><p><b>directnessMatch</b>: ??? <span>(Details : {http://terminology.hl7.org/CodeSystem/directness code 'null' = 'null', given as '???'})</span></p></blockquote><p><b>synthesisType</b>: summary data meta-analysis <span>(Details : {http://terminology.hl7.org/CodeSystem/synthesis-type code 'std-MA' = 'summary data meta-analysis', given as 'summary data meta-analysis'})</span></p><p><b>studyType</b>: randomized trial <span>(Details : {http://terminology.hl7.org/CodeSystem/study-type code 'RCT' = 'randomized trial', given as 'randomized trial'})</span></p><p><b>statistic</b>: , </p><blockquote><p><b>certainty</b></p><p><b>description</b>: Low, due to serious imprecision and indirectness.</p><p><b>rating</b>: Low quality <span>(Details : {http://terminology.hl7.org/CodeSystem/certainty-rating code 'low' = 'Low quality', given as 'Low quality'})</span></p><blockquote><p><b>certaintySubcomponent</b></p><p><b>note</b>: Note that all studies that reported 90 day to 1 year mortality also reported 28-30 day mortality: the CI 95% around the pooled effect for short term mortality also excludes no effect: RR 0.91 (CI 95% 0.84 - 0.98).</p><p><b>type</b>: Risk of bias <span>(Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type code 'RiskOfBias' = 'Risk of bias', given as 'Risk of bias'})</span></p><p><b>rating</b>: no serious concern <span>(Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating code 'no-concern' = 'no serious concern', given as 'no serious concern'})</span></p></blockquote><blockquote><p><b>certaintySubcomponent</b></p><p><b>type</b>: Inconsistency <span>(Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type code 'Inconsistency' = 'Inconsistency', given as 'Inconsistency'})</span></p><p><b>rating</b>: no serious concern <span>(Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating code 'no-concern' = 'no serious concern', given as 'no serious concern'})</span></p></blockquote><blockquote><p><b>certaintySubcomponent</b></p><p><b>note</b>: Only a small proportion of studies reported longer-term mortality.</p><p><b>type</b>: Indirectness <span>(Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type code 'Indirectness' = 'Indirectness', given as 'Indirectness'})</span></p><p><b>rating</b>: serious concern <span>(Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating code 'serious-concern' = 'serious concern', given as 'serious concern'})</span></p></blockquote><blockquote><p><b>certaintySubcomponent</b></p><p><b>note</b>: Confidence interval includes no effect.</p><p><b>type</b>: Imprecision <span>(Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type code 'Imprecision' = 'Imprecision', given as 'Imprecision'})</span></p><p><b>rating</b>: serious concern <span>(Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating code 'serious-concern' = 'serious concern', given as 'serious concern'})</span></p></blockquote><blockquote><p><b>certaintySubcomponent</b></p><p><b>type</b>: Publication bias <span>(Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type code 'PublicationBias' = 'Publication bias', given as 'Publication bias'})</span></p><p><b>rating</b>: no serious concern <span>(Details : {http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating code 'no-concern' = 'no serious concern', given as 'no serious concern'})</span></p></blockquote></blockquote></div>"
},
"title": "Corticosteroids vs No corticosteroids for Patients with Sepsis with Mortality (60 days to 1 year)",
"status": "draft",
"relatedArtifact": [
{
"type": "derived-from",
"url": "https://app.magicapp.org/public/guideline/EZ1w8n/pico/31831/widget?tab=outcome"
}
],
"description": "Mortality reduced with RR 0.94 with Corticosteroids vs no corticosteroids for patients with sepsis",
"referentGroup": {
"description": "Patients with sepsis",
"evidenceSource": {
"type": "Group",
"display": "???"
},
"intendedGroup": {
"type": "Group",
"display": "Patients with sepsis"
},
"directnessMatch": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/directness",
"display": "???"
}
]
}
},
"variableDefinition": [
{
"description": "Mortality Longer term (60 days to 1 year)",
"variableRole": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/variable-role",
"code": "measuredVariable",
"display": "measured variable"
}
]
},
"actualDefinition": {
"type": "EvidenceVariable",
"display": "many studies had shorter term outcomes"
},
"intendedDefinition": {
"type": "EvidenceVariable",
"display": "Mortality Longer term (Follow up: 60 days to 1 year)"
},
"directnessMatch": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/directness",
"code": "moderate",
"display": "moderate"
}
]
}
},
{
"description": "Corticosteroids",
"variableRole": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/variable-role",
"code": "exposure",
"display": "exposure"
}
]
},
"actualDefinition": {
"type": "EvidenceVariable",
"display": "???"
},
"intendedDefinition": {
"type": "EvidenceVariable",
"display": "Corticosteroids"
},
"directnessMatch": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/directness",
"display": "???"
}
]
}
},
{
"description": "No corticosteroids",
"variableRole": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/variable-role",
"code": "referenceExposure",
"display": "referenceExposure"
}
]
},
"actualDefinition": {
"type": "EvidenceVariable",
"display": "???"
},
"intendedDefinition": {
"type": "EvidenceVariable",
"display": "No corticosteroids"
},
"directnessMatch": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/directness",
"display": "???"
}
]
}
}
],
"synthesisType": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/synthesis-type",
"code": "std-MA",
"display": "summary data meta-analysis"
}
]
},
"studyType": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/study-type",
"code": "RCT",
"display": "randomized trial"
}
]
},
"statistic": [
{
"description": "Relative risk 0.94",
"note": [
{
"text": "Based on data from 6438 patients in 9 studies "
}
],
"statisticType": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/statistic-type",
"code": "C93152",
"display": "relative risk"
}
]
},
"quantity": {
"value": 0.94
},
"sampleSize": {
"note": [
{
"text": "Based on data from 6438 patients in 9 studies "
}
],
"numberOfStudies": 9,
"numberOfParticipants": 6438
},
"attributeEstimate": [
{
"description": "(CI 95% 0.89 - 1.00)",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/attribute-estimate-type",
"code": "C53324",
"display": "confidence interval"
}
]
},
"level": 0.95,
"range": {
"low": {
"value": 0.89
},
"high": {
"value": 1.00
}
}
}
]
},
{
"description": "Absolute risk difference: 22 fewer per 1000",
"note": [
{
"text": "Difference: 22 fewer per 1000"
}
],
"statisticType": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/statistic-type",
"code": "0000424",
"display": "absolute risk difference"
}
]
},
"quantity": {
"value": 0.022
},
"sampleSize": {
"note": [
{
"text": "Based on data from 6438 patients in 9 studies "
}
],
"numberOfStudies": 9,
"numberOfParticipants": 6438
},
"attributeEstimate": [
{
"description": "(CI 95% 0.041 - 0.00)",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/attribute-estimate-type",
"code": "C53324",
"display": "confidence interval"
}
]
},
"range": {
"low": {
"value": 0
},
"high": {
"value": 0.041
}
}
}
]
}
],
"certainty": [
{
"description": "Low, due to serious imprecision and indirectness.",
"rating": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/certainty-rating",
"code": "low",
"display": "Low quality"
}
]
}
],
"certaintySubcomponent": [
{
"note": {
"text": "Note that all studies that reported 90 day to 1 year mortality also reported 28-30 day mortality: the CI 95% around the pooled effect for short term mortality also excludes no effect: RR 0.91 (CI 95% 0.84 - 0.98)."
},
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type",
"code": "RiskOfBias",
"display": "Risk of bias"
}
]
}
],
"rating": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating",
"code": "no-concern",
"display": "no serious concern"
}
]
}
]
},
{
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type",
"code": "Inconsistency",
"display": "Inconsistency"
}
]
}
],
"rating": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating",
"code": "no-concern",
"display": "no serious concern"
}
]
}
]
},
{
"note": {
"text": "Only a small proportion of studies reported longer-term mortality."
},
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type",
"code": "Indirectness",
"display": "Indirectness"
}
]
}
],
"rating": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating",
"code": "serious-concern",
"display": "serious concern"
}
]
}
]
},
{
"note": {
"text": "Confidence interval includes no effect."
},
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type",
"code": "Imprecision",
"display": "Imprecision"
}
]
}
],
"rating": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating",
"code": "serious-concern",
"display": "serious concern"
}
]
}
]
},
{
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/certainty-subcomponent-type",
"code": "PublicationBias",
"display": "Publication bias"
}
]
}
],
"rating": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/certainty-subcomponent-rating",
"code": "no-concern",
"display": "no serious concern"
}
]
}
]
}
]
}
]
}
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
FHIR ®© HL7.org 2011+. FHIR CI Build hl7.fhir.core#4.2.0 (GitHub f996518d66) generated on Tue, Dec 31, 2019 21:12+1100.
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