How to Critically Appraise an Article

Jane M Young; Michael J Solomon

Nat Clin Pract Gastroenterol Hepatol. 2009;6(2):82-91.

Conclusions

Critical appraisal is a systematic process through which the strengths and weaknesses of a research study can be identified. This process enables the reader to assess the study's usefulness and whether its findings are trustworthy. The most important component of critical appraisal is careful assessment of the study design; however, other steps, such as evaluation of the statistical methods used, interpretation of the findings and potential conflicts of interest are also essential. Finally, consideration of the importance of the research to one's own patients will help clinicians identify the most relevant, high-quality studies available to guide their clinical practice.

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Reprint Address

Jane M Young, Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, PO Box M157, Missenden Road, NSW 2050, Australia. E-mail: jyoung@email.cs.nsw.gov.au

Cite this: How to Critically Appraise an Article - Medscape - Feb 01, 2009.

Box 1. Ten Questions to Ask when Critically Appraising a Research Article
Is the study question relevant? Does the study add anything new? What type of research question is being asked? Was the study design appropriate for the research question? Did the study methods address the most important potential sources of bias? Was the study performed according to the original protocol? Does the study test a stated hypothesis? Were the statistical analyses performed correctly? Do the data justify the conclusions? Are there any conflicts of interest?

Box 2. Key Methodological Points to Consider in the Appraisal of Systematic Reviews and Meta-analyses
Were all relevant studies included (i.e. was the search comprehensive, did it exclude articles on the basis of publication status or language and was the potential for publication bias assessed)? Were selected articles appraised and data extracted by two independent reviewers? Was sufficient detail provided about the primary studies, including descriptions of the patients, interventions and outcomes? Was the quality of the primary studies assessed? Did the researchers assess the appropriateness of combining results to calculate a summary measure?

Box 3. Key Methodological Points to Consider in the Appraisal of Randomized Controlled Trials
Was the process of treatment allocation truly random? Would participants have been able to know or guess their treatment allocation? Were participants and researchers 'blinded' to participants' treatment group? Were outcomes assessed objectively? Were all participants who were randomly allocated a treatment accounted for in the final analysis? Were all participants' data analyzed in the group to which they were randomly allocated?^a ^aSee section on intention-to-treat analysis under 'Were the statistical analyses performed correctly?'

Box 4. Key Methodological Points to Consider in the Appraisal of a Cohort Study
Is the study prospective or retrospective? Is the cohort representative of a defined group or population? Were all important confounding factors identified? Were all important exposures and/or treatments, potential confounding factors and outcomes measured accurately and objectively in all members of the cohort? Were there important losses to follow-up? Were participants followed up for a sufficient length of time?

Box 5. Key Methodological Points to Consider in the Appraisal of a Case-Control Study
Were the cases clearly defined? Were the cases representative of a defined population? How were the controls selected and were they drawn from the same population as the cases? Were study measures identical for cases and controls? Were study measures objective or subjective and is recall bias likely if they were subjective?

Box 6. Key Methodological Points to Consider in the Appraisal of a Cross-sectional Study
Was the study sample clearly defined? Was a representative sample achieved (e.g. was the response rate sufficiently high)? Were all relevant exposures, potential confounding factors and outcomes measured accurately? Were patients with a wide range of severity of disease assessed?

Box 7. Key Methodological Points to Consider in the Appraisal of a Case Study
Were cases identified prospectively or retrospectively? Are the cases a representative sample (e.g. a consecutive series of individuals recruited from multiple centers) and similar to patients in your practice? Were all relevant exposures, potential confounding factors and outcomes measured accurately?

Box 8. Key Methodological Points to Consider in the Appraisal of a Study of Diagnostic Accuracy
Does the sample of patients represent the full spectrum of patients with and without the diagnosis of interest? Was there a comparison with an appropriate 'gold-standard' test? Did all patients receive both the test under evaluation and the same 'gold-standard' test? Were the tests performed independently with blinding of assessors to the results of the 'gold-standard' test? Were the cut-offs that were used to classify patients as having a positive test result clearly described?

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How to Critically Appraise an Article

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