CAT

(Critical Appraisal of the Topics)

OPUS 12 Scientist 2009 Vol. 3, No. 3

Submitted 09/2010; Revised 10/2010; Re-revised
11/2010; Published 11/2010

SCREEN FOR INITIAL VALIDITY AND

RELEVANCE
This journal was already reviewed by OPUS 12

Scientist USA (peer-reviewed electronic journal)

The study was not sponsored by any organization
that might influence the study design or results
This information will have a direct impact on the
health of our patients
The problem addressed in this journal is to
determine benefits of epidural (epid) versus
intravenous/intramuscular (iv/im) analgesia for
traumatic rib fractures (RFs) by performing a meta
analysis study
This information, will require us to change our
current practice.

DETERMINE THE INTENT OF THE ARTICLE

The

investigators were intended benefits of

epidural (epid) versus intravenous/intramuscular
(iv/im) analgesia for traumatic rib fractures (RFs)
by performing a meta analysis study

Clinical
category

Description

Preferred Study
Design

Therapy

Tests the effectiveness of a

treatment, such as a drug,
surgical procedure, or other
intervention

Randomized, doubleblinded, placebocontrolled trial

Diagnosis

Measures the validity (is it

dependable?) and reliability
(will the same results be
obtained every time?) of a
diagnostic test, or evaluates
the effectiveness of a test in
detecting disease at a pre
symptomatic stage when
applied to a large population

Cross-sectional
survey (comparing
the new test with a
reference standard)

Causation

Assesses whether a substance

is related to the development
of an illness or condition

Cohort or case-

Determines the outcome of a

Longitudinal cohort

disease

study

Prognosis

control

Level 1 of
Evidence
Leve
l

Therapy/Prevention,
Aetiology/Harm

Prognosis

Diagnosis

1a

SR (with
homogeneity*) of
RCTs

SR (with
homogeneity*) of
inception cohort
studies; CDR
validated in
different
populations

SR (with homogeneity*)
of Level 1 diagnostic
studies; CDR with
1b studies from
different clinical
centres

1b

Individual RCT (with

narrow Confidence
Interval)

Individual inception
cohort study with
> 80% follow-up;
CDR validated in
a single
population

Validating** cohort
study with good
reference standards;
or CDR tested
within one clinical
centre

1c

All or none

All or none caseseries

Absolute SpPins and

SnNouts

Level 2 of
Evidence
Leve
l

Therapy/Prevention,
Aetiology/Harm

Prognosis

Diagnosis

2a

SR (with
homogeneity*) of
cohort studies

SR (with
homogeneity*) of
either retrospective
cohort studies or
untreated control
groups in RCTs

SR (with homogeneity*)
of Level >2 diagnostic
studies

2b

Individual cohort study

(including low quality
RCT; e.g., <80%
follow-up)

Retrospective
cohort study or
follow-up of
untreated control
patients in an RCT;
Derivation of CDR
or validated on
split-sample only

Exploratory** cohort
study with good
reference standards;
CDR after derivation,
or validated only on
split-sample or
databases

2c

Outcomes" Research;"
Ecological studies

Outcomes""
Research

Level 3,4,5 of
Evidence
Leve
l

Therapy/Prevention,
Aetiology/Harm

Prognosis

Diagnosis

3a

SR (with
homogeneity*) of
case-control studies

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

3b

Individual CaseControl Study

Non-consecutive study;
or without consistently
applied reference
standards

Case-series (and poor

quality cohort and
case-control studies)

Case-series (and
poor quality
prognostic cohort
studies***)

Case-control study,
poor or nonindependent reference
standard

Expert opinion without

explicit critical
appraisal, or based on
physiology, bench
research or "first
"principles

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

Expert opinion without

explicit critical
appraisal, or based on
physiology, bench
research or "first
"principles

Grades of
Recommendation
A

consistent level 1 studies

consistent level 2 or 3 studies or

extrapolations from level 1 studies

level 4 studies or extrapolations from

level 2 or 3 studies

level 5 evidence or troublingly

inconsistent or inconclusive studies of
any level

THANK YOU