Critical Appraisal of The

Topics
 ARTICLE INFORMATION
• Received to published: 19th March 2020
• Published in a manner on line: 31st July 2020
doi: (https://doi.org/10.1186/s13017-020-00324-1)
• Endorsement: Open access funding provided by Projekt DEAL
 FILTERING FOR VALIDITY EARLY AND
RELEVANCE
1. Is the article a peer-reviewed journal? Yes
2. Is this research location, if valid, will be used for the benefit of my
practice? Yes
3. Whether this research is sponsored by an organization that may be
involved in the design of the research data? No
 FILTERING FOR VALIDITY EARLY AND
RELEVANCE
4. Would this information, if true, have a direct impact on the health
of my patients and will it be meaningful to them ? Yes
5. Whether this problem is something that is frequently encountered
in my place of practice, and whether the intervention or test can be
used and is available for me to use ? Yes
6. Would this information, if correct, lead me to change my current
practice ? Yes
 LEVEL 1 OF EVIDENCE
Level Therapy/Prevention, Prognosis Diagnosis
Aetiology/Harm
1a SR (with homogeneity*) SR (with homogeneity*) SR (with homogeneity*)
of RCTs of inception cohort of Level 1 diagnostic
studies: CDR± validated studies; CDR± with 1b
in different populations studies from different
clinical centres

1b Individual RCT (with Individual inception Validating** cohort study

narrow Confidence cohort study with > 80% with good±±± reference
Interval±) follow-up; CDR± standards; or CDR±
validated in a single tested within one clinical
population centre

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

SnNouts±±
 LEVEL 2 OF EVIDENCE
Level Therapy/Prevention, Prognosis Diagnosis
Aetiology/Harm
2a SR (with homogeneity*) SR (with homogeneity*) SR (with homogeneity*)
of cohort studies of either retrospective of Level >2 diagnostic
cohort studies or studies
untreated control groups
in RCTs

2b Individual cohort study Retrospective cohort Exploratory** cohort

(including low quality study or follow-up of study with good±±±
RCT; e.g., <80% follow- untreated control reference standards;
up) patients in an RCT; 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
 LEVEL 3, 4, 5 OF EVIDENCE
Level Therapy/Prevention, Prognosis Diagnosis
Aetiology/Harm
3a SR (with homogeneity*) SR (with homogeneity*)
of cohort studies of 3b and better studies
3b Individual Case-Control Non-consecutive study;
Study or without consistently
applied reference
standards
4 Case-series (and poor Case-series (and poor Case-control study, poor
quality cohort and quality prognostic cohort or non-independent
case-control studies) studies***) reference standard

5 Expert opinion without Expert opinion without Expert opinion without

explicit critical explicit critical appraisal, explicit critical appraisal,
appraisal, or based on or based on physiology, or based on physiology,
physiology, bench bench research or "first bench research or "first
research or "first principles" principles"
principles"
 GRADE 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 pf any

level
THANK YOU