Critical Appraisal Forms

From Evidence-Based Medicine, How to practice and teach EBM

Diagnosis
Title: Authors: Reference: Validity: 1) Was there an independent blind comparison to a gold standard? 2) Did the patient sample include an appropriate spectrum of patients to whom you might apply the test in clinical practice? 3) Was the gold standard applied regardless of the diagnostic test result? 4) Was the test validated in a second independent group of patients Importance: 1) Do the results demonstrate the ability of this test to accurately distinguish patients who do and dont have a disorder?

Applicability: 1) Is this test available, affordable, accurate and precise in our setting? 2) Can we generate a clinically sensible estimate of our patients pre-test probability? 3) Will the resulting post-test probabilities affect our management and help our patient?

Screening
Title: Authors: Reference: Screening validity, importance and applicability: 1) Is there RCT evidence that early diagnosis really leads to improved survival, or quality of life or both? 2) Are the early diagnosed patients willing partners in the treatment strategy? 3) How do benefits and harms compare in different people and with different screening strategies? 4) Do the frequency and severity of the target disorder warrant the degree of effort and expenditure?

Prognosis
Title: Authors: Reference: Validity: 1) Was a defined representative sample assembled at a common point in the course of the disease? 2) Was patient follow-up sufficiently long and complete? 3) Were objective outcome criteria applied in a blind fashion? 4) If subgroups with different prognoses are identified, was there an adjustment for independent prognostic factors and validation with an independent group of test patients? Importance: 1) How likely are the outcomes over time? 2) How precise are the prognostic estimates? Applicability: 1) Is our patient so different from those in the study that its results cannot apply? 2) Will this evidence make a clinically relevant impact on the decision our patient will make?

Therapy
Title: Authors: Reference: Validity: 1) Was assignment to the study random? 2) Was the randomization concealed? 3) Were the groups similar (matching) at the beginning of the trial? 4) Was follow-up sufficiently long and complete? 5) Were all patients analyzed into groups they were assignedintention to treat/screen analysis? 6) Were the patients and clinician kept blind to treatment? 7) Were the groups treated equally? Importance: 1) How large was the treatment effect and how is defined? 2) How precise is the estimate of treatment effect? Applicability: 1) Is our patient so different from the study population that the results cannot apply? 2) Is the treatment feasible in our setting? 3) What are our patients potential benefits and harms? 4) What are our patients values and expectations for both the treatment and outcome we are trying to prevent?

Systematic Reviews
Title: Authors: Reference: Validity: 1) Is this a systematic review of randomized trials? 2) Does it describe a comprehensive and detailed search for relevant trials? 3) Were the individual studies assessed for validity? Importance: 1) Are the results consistent across studies? 2) What is the magnitude of the treatment effect? 3) How precise is the treatment effect? Applicability: 1) Is our patient so different from the study population that the results cannot apply? 2) Is the treatment feasible in our setting? 3) What are our patients potential benefits and harms? 4) What are our patients values and expectations for both the treatment and outcome we are trying to prevent?

Harm
Title: Authors: Reference: Validity: 1) Where there clearly defined groups of patients, similar in all important ways other than exposure to the treatment or other cause? 2) Were treatments/exposures and clinical outcomes measured in the same ways in both groups? Was the assessment of outcomes either objective or blinded to exposure? 3) Was the follow-up of the study sufficiently long and complete? 4) Do the results of the harm study satisfy some of the tests for causation? Importance: 1) What is the magnitude of the association between the exposure and outcome? 2) What is the precision of the estimate of the association between the exposure and the outcome? Applicability: 1) Is our patient so different from those included in the study that its results cannot apply? 2) What is our patients risk of benefit and harm from the agent? 3) What are our patients preferences, concerns and expectations from this treatment? 4) What alternative treatments are available?