Critical Appraisal of the

Topics
 ARTICLE
INFORMATION
• Received to published : 3rd July 2020
• Published in a manner on line : 3rd October 2020
doi: (https://doi.org/10.1016/j.breast.2020.09.005)
• Endorsement: was supported by grants from Instituto de
Salud Carlos III FEDER and by the Research Network on
Health Services in Chronic Diseases
 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 EVIDANCE

Level Therapy/Prevention, Prognosis Diagnosis

Aetiology/Harm
1a SR (with homogeneity*) of SR (with homogeneity*) of SR (with homogeneity*) of
RCTs inception cohort studies: Level 1 diagnostic studies;
CDR± validated in different CDR± with 1b studies from
populations different clinical centres

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

(including low quality RCT; follow-up of untreated control with good±±± reference
e.g., <80% follow- up) patients in an RCT; Derivation standards; CDR± after
of CDR± or validated on split- derivation, or validated only
sample only on split-sample or databases

2c "Outcomes" Research; "Outcomes" Research

Ecological studies
 LEVEL 3,4,5 OF EVIDENCE

Level Therapy/Prevention, Prognosis Diagnosis

Aetiology/Harm
3a SR (with homogeneity*) of SR (with homogeneity*) of 3b
cohort studies and better studies

3b Individual Case-Control Non-consecutive study; or

Study without consistently applied
reference standards

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

5 Expert opinion without Expert opinion without explicit Expert opinion without explicit
explicit critical appraisal, or critical appraisal, or based on critical appraisal, or based on
based on physiology, bench physiology, bench research or physiology, bench research or
research or "first principles" "first principles" "first principles"
GRADE OF RECOMENDATION

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