Critical Appraisal of the Topics

 Is the article from a peer-reviewed journal ?

Screen for This article is from peer-reviewed journal
Initial Journal of the Turkish Society of Otorhinolaryngology and
Head and Neck Surgery
Validity Received 10th January 2017; Published 16th August 2017
and  Is the study sponsored by an organization that might influence the
Relevance study design or results ?
This research is not supported by any organization
  Will this information, if true, have a direct impact on the health of
Screen for my patients, and is it something they will care about ?
This information, if true, have a direct impact on the health
Initial of our patients, and something they will care about
Validity  Is the problem addressed one that is common to my practice, and
is the intervention or test feasible and available to me ?
and The problem is common to my practice and the intervention
Relevance or test feasible and available to us
  Why the study was performed
To compare the outcomes of securing full-thickness skin
Determine grafting (FTSG) with through-and-through mattress suturing
versus the classic tie-over and pressure dressing and identify
the Intent the associated risk factors of graft failure.

of the  What clinical questions the investigators were addressing

Article Which technic has a better outcomes in securing full-

thickness skin grafting (FTSG) between through-and-
through mattress suturing and the classic tie-over and
pressure dressing
Will the Can the result applied to the local population ? YES
result help
me locally
 Retrospective study, the recruited studies were not all
randomized controlled trials

Single centre Study.

Disadvant
ages

6
  Four major clinical categories
Determine Therapy
the Intent  Diagnosis

of the  Causation
 Prognosis
Article
 Clinical Description Preferred Study
category Design

Therapy Tests the effectiveness of a Randomized, double-

Evaluate
treatment, such as a drug, surgical blinded, placebo-
procedure, or other intervention controlled trial

the Diagnosis Measures the validity (is it

dependable?) and reliability (will the
Cross-sectional survey
(comparing the new test

Validity of same results be obtained every

time?) of a diagnostic test, or
with a reference
standard)

the Article evaluates the effectiveness of a test

in detecting disease at a pre-

Based on symptomatic stage when applied to a

large population

Its Intent Causation Assesses whether a substance is

related to the development of an
Cohort or case-control
illness or condition
Prognosis Determines the outcome of a disease Longitudinal cohort
study
 Therapy/Prevention,
Level Prognosis Diagnosis
Aetiology/Harm
1a SR (with homogeneity*) of SR (with homogeneity*) SR (with homogeneity*) of
RCTs of inception cohort Level 1 diagnostic
studies; CDR† studies; CDR† with 1b
validated in different studies from different
populations clinical centres

Level 1 of
Evidence 1b Individual RCT (with Individual inception Validating** cohort study with
narrow Confidence cohort study with > good††† reference
Interval‡) 80% follow-up; standards; or CDR†
CDR† validated in a tested within one clinical
single population centre

1c All or none§ All or none case-series Absolute SpPins and

SnNouts††
 Therapy/Prevention,
Level Prognosis Diagnosis
Aetiology/Harm
2a SR (with homogeneity* ) of SR (with homogeneity*) of SR (with homogeneity*) of
cohort studies either retrospective cohort Level >2 diagnostic studies
studies or untreated
Level 2 of 2b Individual cohort study
control groups in RCTs
Retrospective cohort study Exploratory** cohort study with
Evidence (including low quality RCT;
e.g., <80% follow-up)
or follow-up of untreated
control patients in an RCT;
good†††reference standards;
CDR† after derivation, or
Derivation of CDR† or validated only on split-
validated on split- sample§§§ or databases
sample§§§ only
2c "Outcomes" Research; "Outcomes" Research
Ecological studies
 Therapy/Prevention,
Level Prognosis Diagnosis
Aetiology/Harm

SR (with homogeneity*) of SR (with homogeneity*) of 3b and

3a case-control studies better studies

Individual Case-Control Study Non-consecutive study; or without

Level 3,4,5 3b
consistently applied reference
standards

of Evidence Case-series (and poor quality Case-series (and poor Case-control study, poor or non-
4 cohort and case-control quality prognostic cohort independent reference standard
studies§§ ) studies***)

Expert opinion without explicit Expert opinion without Expert opinion without explicit
critical appraisal, or based on explicit critical appraisal, or critical appraisal, or based on
physiology, bench research or based on physiology, bench physiology, bench research or
5 "first principles" research or "first principles" "first principles"
 A consistent level 1 studies

consistent level 2 or 3 studies or extrapolations

B
Grades of from level 1 studies

Recommen C
level 4 studies or extrapolations from level 2 or
3 studies
dation
level 5 evidence or troublingly inconsistent or
D
inconclusive studies of any level
thank you..