CAT

(Critical Appraisal of the Topics)

Partial thyroidectomy for papillary

thyroid microcarcinoma: Is
completion total thyroidectomy
indicated?
Screen for Initial Validity and
Relevance
1. Is the article from a peer-reviewed
journal ? Yes
2. Is the location of the study similar to
mine so that the results, if valid, would
apply to my practice ? No
3. Is the study sponsored by an organization
that might influence the study design or
results ? No
4. Will this information, if true, have a direct
impact on the health of my patients, and is
it something they will care about ? Yes
5. Is the problem addressed one that is
common to my practice, and is the
intervention or test feasible and available
to me ? Yes
6. Will this information, if true, require me
to change my current practice ? No
 Clinical category Description Prefered Study Design

Therapy Tests the effectiveness of a treatment, Randomized, double-

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

Diagnosis Measures the validity and reliability of a Case control study

diagnostic test, or evaluates the
effectiveness of a test in detecting disease at
a presymptomatic stage when applied to a
large population

Causation Assesses whether a substance is related to

Cohort or case-control
the development of an illness or condition

Prognosis
Determines the outcome of a disease Longitudinal cohort study
 Level of Evidence
Level Therapy/Prevention, Prognosis Diagnosis
Aetiology/Harm

1a SR (with homogeneity*) SR (with homogeneity*) SR (with homogeneity*) of

of RCTs of inception cohort Level 1 diagnostic
studies; CDR† studies; CDR† with 1b
validated in studies from different
different clinical centres
populations

1b Individual RCT (with Individual inception Validating case control

narrow Confidence cohort study with > study with good
Interval‡) 80% follow-up; reference standards; or
CDR† validated in a Clinical Data
single population Repository tested
within one clinical
centre
1c All or none§ All or none case-series Absolute SpPins and
SnNouts††
 Level of Evidence
Level Therapy/Prevention, 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
2b Individual cohort study Retrospective cohort Exploratory** cohort study with
(including low quality RCT; study or follow-up of good†††reference standards;
e.g., <80% follow-up) untreated control patients CDR† after derivation, or
in an RCT; Derivation of validated only on split-sample
CDR† or validated on or databases
split-sample only
2c "Outcomes" Research; "Outcomes" Research
Ecological studies
 Level of Evidence
Level Therapy/Prevention, Prognosis Diagnosis
Aetiology/Harm
3a SR (with homogeneity*) of SR (with homogeneity*) of 3b
case-control studies and better studies
3b Individual Case-Control Non-consecutive study; or
Study without consistently applied
reference standards

4 Case-series (and poor quality
cohort and case-control
studies§§ )
5 Expert opinion without
explicit critical appraisal, or
based on physiology, bench
research or "first principles"
Case-series (and poor
quality prognostic cohort
studies***)
Expert opinion without
explicit critical appraisal,
or based on physiology,
bench research or "first
principles"
Case-control study, poor or
non-independent reference
standard
Expert opinion without explicit
critical appraisal, or based on
physiology, bench research or
"first principles"
Grades of Recommendation
A consistent level 1 studies

B consistent level 2 or 3 studies or

extrapolations from level 1 studies
C level 4 studies or extrapolations from
level 2 or 3 studies
D level 5 evidence or troublingly
inconsistent or inconclusive studies of
any level