Critical Appraisal of the Topics

Is the article from a peer-reviewed journal ?

This article is from peer-reviewed journal

Screen for International Journal of Medical Science and Public Health

Initial Received 9 August 2014; accepted 27 August 2014

Is the location of the study similar to mine so that the results, if
Validity valid, would apply to my practice ?
and The location of the study is similar to ours so that the
results, if valid, would apply to my practice
Relevance Is the study sponsored by an organization that might influence the
study design or results ?
This research is not supported by any organization
 Will this information, if true, have a direct impact on the health of
my patients, and is it something they will care about ?
This information, if true, have a direct impact on the health
Screen for of our patients, and something they will care about
Is the problem addressed one that is common to my practice, and
Initial is the intervention or test feasible and available to me ?
Validity The problem is common to my practice, and the
intervention or test feasible and available to us
and Will this information, if true, require me to change my current
Relevance practice ?
This information, if true, require us to change our current
practice
 Why the study was performed
To study the various associated intracranial injury
Determine with depressed skull fracture (DSF) and to
establish a plan of management of DSF.
the Intent What clinical questions the investigators were
of the addressing
Article How are the various associated intracranial injury
with depressed skull fracture (DSF) and the plan of
management of DSF ?
Will the Can the result applied to the local population ? YES
result help
me locally
 The current study had a small study sample.

Single centre Study.

Disadvant
ages

Involved only a short-term follow-up

6
 Four major clinical categories
Determine Therapy
the Intent Diagnosis
Causation
of the Prognosis
Article
 Clinical Description Preferred Study
category Design

Therapy Tests the effectiveness of a Randomized, double-

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

the Diagnosis Measures the validity (is it

dependable?) and reliability (will the
Cross-sectional survey
(comparing the new test

Validity of same results be obtained every

time?) of a diagnostic test, or
with a reference
standard)

the Article evaluates the effectiveness of a test

in detecting disease at a pre-

Based on symptomatic stage when applied to a

large population

Its Intent Causation Assesses whether a substance is

related to the development of an
Cohort or case-control
illness or condition
Prognosis Determines the outcome of a disease Longitudinal cohort
study
 Therapy/Prevention,
Level Prognosis Diagnosis
Aetiology/Harm
1a SR (with homogeneity*) of SR (with homogeneity*) SR (with homogeneity*) of
RCTs of inception cohort Level 1 diagnostic
studies; CDR studies; CDR with 1b
validated in different studies from different
populations clinical centres

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

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

SnNouts
 Therapy/Prevention,
Level 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
Level 2 of 2b Individual cohort study
control groups in RCTs
Retrospective cohort study Exploratory** cohort study with
Evidence (including low quality RCT;
e.g., <80% follow-up)
or follow-up of untreated
control patients in an RCT;
goodreference standards;
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
 Therapy/Prevention,
Level Prognosis Diagnosis
Aetiology/Harm

SR (with homogeneity*) of SR (with homogeneity*) of 3b and

3a case-control studies better studies

Individual Case-Control Study Non-consecutive study; or without

Level 3,4,5 3b
consistently applied reference
standards

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

Expert opinion without explicit Expert opinion without Expert opinion without explicit
critical appraisal, or based on explicit critical appraisal, or critical appraisal, or based on
physiology, bench research or based on physiology, bench physiology, bench research or
5 "first principles" research or "first principles" "first principles"
 A consistent level 1 studies

consistent level 2 or 3 studies or extrapolations

B
Grades of from level 1 studies

Recommen C
level 4 studies or extrapolations from level 2 or
3 studies
dation
level 5 evidence or troublingly inconsistent or
D
inconclusive studies of any level
thank you..