Critical Appraisal of the Topics

 Is the article from a peer-reviewed journal ?

This article is from peer-reviewed journal
International Journal of Medical Science and Public Health
Screen for Received 9 August 2014; accepted 27 August 2014
Initial  Is the location of the study similar to mine so that the results, if
valid, would apply to my practice ?
Validity and
The location of the study is similar to ours so that the
Relevance results, if valid, would apply to my practice
 Is the study sponsored by an organization that might influence the
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
my patients, and is it something they will care about ?
This information, if true, have a direct impact on the health
of our patients, and something they will care about

Screen for  Is the problem addressed one that is common to my practice, and
is the intervention or test feasible and available to me ?
Initial The problem is common to my practice, and the
Validity and intervention or test feasible and available to us

Relevance  Will this information, if true, require me to change my current

practice ?
This information, if true, require us to change our current
practice
  Why the study was performed
To study the various associated intracranial injury
with depressed skull fracture (DSF) and to
Determine establish a plan of management of DSF.
the Intent of  What clinical questions the investigators were
addressing
the Article
How are the various associated intracranial injury
with depressed skull fracture (DSF) and the plan of
management of DSF ?
Will the Can the result applied to the local population ? YES
result help
me locally
 The current study had a small study sample.

Single centre Study.

Disadvanta
ges
Involved only a short-term follow-up

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

the Article  Prognosis

 Clinical Description Preferred Study Design
category
Therapy Tests the effectiveness of a Randomized, double-
treatment, such as a drug, surgical blinded, placebo-
procedure, or other intervention controlled trial
Evaluate Diagnosis Measures the validity (is it
dependable?) and reliability (will the
Cross-sectional survey
(comparing the new test
the Validity same results be obtained every
time?) of a diagnostic test, or
with a reference
standard)
of the evaluates the effectiveness of a test
in detecting disease at a pre-

Article symptomatic stage when applied to a

large population

Based on Its Causation Assesses whether a substance is

related to the development of an
Cohort or case-control

Intent Prognosis
illness or condition

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

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

3a control studies better studies

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

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

of Evidence Case-series (and Case-series (and Case-control study, poor or non-

poor quality cohort and case-con poor quality prognostic cohor independent reference standard
4
trol studies§§ t 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
from level 1 studies
Grades of
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..