Critical Appraisal Checklist: Diagnostic Test Study

For clinicians to use a diagnostic test in clinical practice, they need to know how well the test distinguishes between those who have the suspected disease or condition and those who do not. Diagnostic test studies evaluate a test for diagnosing a disease.

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What did they do? (Methods)

What was the answer? (Results)

What did they say about the answer? (Conclusion)

What do I do with this information?

1. Was there an independent, blind comparison with reference to a “gold” standard?

2. Was the test evaluated in an appropriate spectrum of patients (like those in whom we would use it in practice)?

3. Was the reference standard ascertained regardless of the diagnostic test result?

1. What likelihood ratios are associated with the range of possible test results?

1. Do the results of the study support the author/s conclusions?

2. Does the conclusion reflect the discussion?

3. Are there study limitations, and do these impact the conclusions?

4. Are potential discrepancies mentioned?

1. Will the reproducibility of the test result and its interpretation be satisfactory in my setting?

2. Are the results applicable to my patient?

3. Will the results change my management?

4. Will patients be better off as a result of the test?

5. Are the benefits woth the potential harms and costs?

Critical Appraisal Checklist: Differential Diagnosis

Differential Diagnosis involves the process of weighing the probability that one disease rather than another disease accounts for a patient’s illness. The Differential Diagnosis Study tries to sort out what proportion of the patients with a single sign or symptom has various diseases.

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What did they do? (Methods)

What was the answer? (Results)

What did they say about the answer? (Conclusion)

What do I do with this information?

1. Did the investigators enroll the right patients?

2. Was the patient sample representative of those with the clinical problem?

3. Was the definitive diagnostic standard appropriate?

4. Was the diagnostic process credible?

5. For initially undiagnosed patients, was follow-up sufficiently long and complete?

1. What were the diagnoses and their probabilities?

2. How precise are these estimates of disease probability?

1. Do the results of the study support the author/s conclusions?

2. Does the conclusion reflect the discussion?

3. Are there study limitations, and do these impact the conclusions?

4. Are potential discrepancies mentioned?

1. Are the study patients similar to my own?

2. Is it unlikely that the disease possibilities or probabilities have changed since this evidence was gathered?

Critical Appraisal Checklist: Economic Analysis

An economic analysis can provide accurate values to assess the cost of disease and the cost-benefit of interventions.

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What did they do? (Methods)

What was the answer? (Results)

What did they say about the answer? (Conclusion)

What do I do with this information?

1. Did the analysis provide a full economic comparison of health care strategies?

2. Were the costs and outcomes properly measured and valued?

3. Was appropriate allowance made for uncertainties in the analysis?

4. Are estimates of costs and outcomes related to the baseline risk in the treatment population?

1. What were the incremental costs and outcomes of each strategy?

2. Do incremental costs and outcomes differ between subgroups?

3. How much does allowance for uncertainty change the results?

1. Do the results of the study support the author/s conclusions?

2. Does the conclusion reflect the discussion?

3. Are there study limitations, and do these impact the conclusions?

4. Are potential discrepancies mentioned?

1. Are the treatment benefits worth the harms and costs?

2. Could my patients expect similar health outcomes?

3. Could I expect similar costs?

Critical Appraisal Checklist: Harm / Etiology

A Harm/Etiology study addresses how to identify causes for disease (including iatrogenic forms – ie caused by the healthcare system)

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What did they do? (Methods)

What was the answer? (Results)

What did they say about the answer? (Conclusion)

What do I do with this information?

1. Were there clearly defined groups of patients, similar in all important ways other than exposure to the treatment or other cause?

2. Were the treatments/exposures and clinical outcomes measured in the same ways in both groups? (Was the assessment of outcomes either objective or blinded to exposure?

3. Was the follow-up of the study patients sufficiently long (for the outcome to occur) and complete?

4. Do the results of the harm study fulfill some of the diagnostic tests for causation?

5. Were the outcomes and exposures measured in the same way in the groups being compared?

1. How strong is the association between exposure and outcome?

2. How precise is the estimate of risk?

1. Do the results of the study support the author/s conclusions?

2. Does the conclusion reflect the discussion?

3. Are there study limitations, and do these impact the conclusions?

4. Are potential discrepancies mentioned?

1. Were the study patients similar to the patient in my practice?

2. Was the duration of follow-up adequate?

3. What was the magnitude of the risk?

4. Should I attempt to stop the exposure?

Critical Appraisal Checklist: Prognostic

A prognostic study addresses how to estimate the patient’s likely clinical course over time and anticipate likely complications of disease.

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What did they do? (Methods)

What was the answer? (Results)

What did they say about the answer? (Conclusion)

What do I do with this information?

1. Was the sample of patients representative?

2. Were the patients significantly homogeneous with respect to prognostic risk?

3. Was follow-up complete?

4. Were objective and unbiased outcome criteria used?

5. If subgroups with different prognoses are identified:

was there adjustment for important prognostic factors?

was there vadidation in an independent group of "test-set" patients?

1. How likely are the outcomes over time?

2. How precise are the estimates of likelihood?

1. Do the results of the study support the author/s conclusions?

2. Does the conclusion reflect the discussion?

3. Are there study limitations, and do these impact the conclusions?

4. Are potential discrepancies mentioned?

1. Were the study patients and their management similar to those in my practice?

2. Was the follow-up sufficiently long?

3. Can I use the results in the management of patients in my practice?

Critical Appraisal Checklist: Practice Guideline

A practice guideline study is a systematically developed statement on medical practice that assists a practitioner and a patient in making decisions about appropriate health care for specific medical conditions.

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What did they do? (Methods)

What was the answer? (Results)

What did they say about the answer? (Conclusion)

What do I do with this information?

1. Did the recommendations consider all relevant patient groups, management options, and possible outcomes?

2. Is there a systematic review of evidence linking options to outcomes for each relevant question?

3. Is each of its recommendations both tagged by the level of evidence upon which it is based and linked to a specific citation?

4. Do the authors indicate the strength of their recommendations?

1. What are the key recommendations?

1. Do the results of the study support the author/s conclusions?

2. Does the conclusion reflect the discussion?

3. Are there study limitations, and do these impact the conclusions?

4. Are potential discrepancies mentioned?

1. Do the recommendations make sense in my practice setting?

Critical Appraisal Checklist: Qualitative

A qualitative study deals with phenomena that are difficult or impossible to quantify mathematically, such as beliefs, meanings, attributes, and symbols.

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What did they do? (Methods)

What was the answer? (Results)

What did they say about the answer? (Conclusion)

What do I do with this information?

1. Was the choice of participants explicit and comprehensive?

2. Was data collection sufficiently comprehensive and detailed?

3. Were the data analyzed appropriately and the findings corroborated adequately?

1. What are the results of the study?

1. Does the study offer helpful theoretical conclusions?

2. Does the conclusion reflect the discussion?

3. Are there study limitations, and do these impact the conclusions?

4. Are potential discrepancies mentioned?

1. Does the study help me understand the context of my practice?

2. Does the study help me to understand my relationships with patients and their families?

Critical Appraisal Checklist: Systematic Review

A systematic review is a literature review focused on a single question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. A meta-analysis is a survey in which the results of all of the included studies are similar enough statistically that the results are combined and analyzed as if they were one study.

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What did they do? (Methods)

What was the answer? (Results)

What did they say about the answer? (Conclusion)

What do I do with this information?

1. Did the review explicitly address a sensible question?

2. Was the search for relevant studies detailed and exhaustive?

3. Were the primary studies of high methodologic quality?

4. Were the assessments of included studies reproducible?

1. What are the overall results of the review?

2. Were the results similar from study to study?

1. Do the results of the study support the author/s conclusions?

2. Does the conclusion reflect the discussion?

3. Are there study limitations, and do these impact the conclusions?

4. Are potential discrepancies mentioned?

1. How can I best interpret the results to apply them to the care of patients in my practice?

2. Were all patient important outcomes considered?

3. Are the benefits worth the potential costs and risks?

Critical Appraisal Checklist: Therapy

A therapy study addresses how to select treatments to offer patients that do more good than harm and that are worth the efforts and costs of using them.

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What did they do? (Methods)

What was the answer? (Results)

What did they say about the answer? (Conclusion)

What do I do with this information?

1. Were patients randomized?

2. Was randomization concealed?

3. Were patients analyzed in the groups to which they were randomized?

4. Were patients in the treatment and control groups similar with respect to known prognostic factors?

5. Were 5 important groups (patients, caregivers, collectors of outcome data, adjudicators of outcome, data analysts) aware of group allocation?

6. Aside from the experimental intervention, were the groups treated equally?

7. Was follow-up complete?

1. How large was the treatment effect?

2. How precise was the estimate of the treatment effect?

1. Do the results of the study support the author/s conclusions?

2. Does the conclusion reflect the discussion?

3. Are there study limitations, and do these impact the conclusions?

4. Are potential discrepancies mentioned?

1. Were the study patients similar to my patients?

2. Were all patient important outcomes considered?

3. Are the likely benefits worth the potential harms and costs?