Critical Appraisal of a

Journal
• Name of Study: Screen time of infants in Sydney, Australia: a birth
cohort study
• Type of Study: Cohort
• Research Objective: To determine the amount of daily screen time in
children 18 months of age and ascertain correlations that may be
contributing to excessive screen use.
• Population: Parents of 500 children with infants 18 months of age
residing in South Western Sydney.
• Methodology: Questionnaire
Internal validity
The study addresses an appropriate and
clearly focused question.
• YES
1. Determine the average amount of daily screen time (television,
DVDs, electronic games) in children 18 months of age residing in
South Western Sydney (SWS)
2. Correlations that may be contributing to excess screen exposure in
this sample.
The two groups being studied are selected from source populations
that are comparable in all respects other than the factor under
investigation.
• YES.
• South Western Sydney is the largest and fastest growing region in
New South Wales, Australia, and has one of the most
socioeconomically disadvantaged communities in the state.
The likelihood that some eligible subjects might have the outcome
at the time of enrolment is assessed and taken into account in the
analysis.
• NO
• No mention of this possibility was stated in the journal.
What percentage of individuals or clusters recruited into each
arm of the study dropped out before the study was completed.
• 9.8% dropped out before the study was completed.
• Of the 500 participants, 49 participants where dropped.
Comparison is made between full participants
and those lost to follow up, by exposure status.
• CAN’T SAY. Dropout rates are mentioned, but no follow-up
information is provided.
• Three call backs were attempted and then a text message left when
participants did not respond.
The outcomes are clearly defined.
• YES. Endpoints or outcomes were clearly specified and used in the
analysis.
• Information about screen time was collected at 18 months.
The assessment of outcome is made blind to
exposure status.
• NO. The assessors could have been blinded, but were not.
Where blinding was not possible, there is some recognition that
knowledge of exposure status could have influenced the assessment
of outcome.
• YES. The process measures are detailed across groups, and are the
same or similar for each.
• The study used data collected from a larger birth cohort study, the
Watch Me Grow (WMG) study. The birth cohort was followed with
telephone interviews at 6, 12 and 18 months of age. Information
about screen time was collected at the 18-month follow-up.
The method of assessment of exposure is
reliable.
• YES. The measures used are clearly defined and have a known degree
of accuracy.
Evidence from other sources is used to demonstrate that
the method of outcome assessment is valid and reliable.
• YES. There where clearly identified primary outcome measures used
in the analysis.
Exposure level or prognostic factor is
assessed more than once.
• NO. The exposure was only checked once.
The main potential confounders are identified and
taken into account in the design and analysis.
• CAN’T SAY. Confounding variables were mentioned, but no comment
on or analysis of potential impact on results were made.
Have confidence intervals been provided?
• Yes.
OVERALL ASSESSMENT OF
THE STUDY
How well was the study done to minimise the
risk of bias or confounding?
• Low quality (0): The cohort study has significant flaws relating to key
aspects of study design. Conclusions likely to change in the light of
further studies.
Taking into account clinical considerations, your evaluation of the
methodology used, and the statistical power of the study, do you think
there is clear evidence of an association between exposure and outcome?

• There is no clear evidence of an association between exposure and

outcome.
Are the results of this study directly applicable
to the patient group targeted in this guideline?
• YES.
In Summary…
• The study has shown that a high proportion of very young children
are being exposed to excessive amounts of screen time. But problems
with confirming the outcome being present at the time of enrollment,
lack of multiple exposure checkpoints, and the lack of confounding
variables make this study of low quality.
• Critical appraisal notes and checklists are lifted from