critical appraisal example systematic review and meta-analysis

Appraisal of a systematic review Appraisal of a systematic review using a checklist: Notes and using a checklist: Notes and ExampleExample

Nouran Hamza, BSc Pharm, MSc, DPHBiostatistician

Vasopressors for the Treatment of Septic Shock: Systematic Review and Meta-Analysis

Tomer Avni, Adi Lador, Shaul Lev, Leonard Leibovici, Mical Paul, Alon Grossman

The content of this presentation relates ONLY to SRs of RCTs with meta-analysis

What question (PICO) did the systematic review address?

•Problem/Patient/Population, •Intervention/Indicator,•Comparison•Outcome, •and(optional) Time  element  or Type  of Study

The Title, Abstract or final paragraph of the Introduction

Description Where to find?

Abstract

Final paragraph in the introduction

Title

Does the SR perform and report a comprehensive and reproducible literature search?

•The starting point for comprehensive search for all relevant studies is the major bibliographic databases (e.g., Medline, Cochrane, EMBASE, etc) • Shall include a search of reference lists from relevant studies, and contact with experts, particularly to inquire about unpublished studies.• The search should not be limited to English language only. • The search strategy should include both MESH terms and text words.

The method sectionResultsLook  for  a  flow  diagram  identifying  the literature search

Description

Where to find?

Method

Results:

Flow chart:

Does the methods section explicitly state the basis for the inclusion or exclusion of primary studies?

•The inclusion and exclusion of studies in a systematic review should be clearly defined •. The eligibility criteria used shall specify the patients, interventions or exposures and outcomes of interest.• The type of study design will also be a master component of the eligibility criteria.

The Methods section should describe the inclusion and exclusion criteria in details

Description

Where to find?

Methods:

The author had also included supported file :

Does the SR assess the methodological quality of primary studies, and take these into account?

•The Jadad score is a well recognised and often reported quality score•A review may use other categorisations of methodological quality. However, it should be clearly explain with justification for the calculations•Other methods might also be acceptable (e.g., randomization, blinding and completeness of follow-up)

The Methods section should describe the assessment of quality and the criteria used. The Results section should provide information on the quality of the individual studies.

Description Where to find?

Methods:

Does the SR state how the results are combined statistically?

•The review should clearly states the statistical procedure

The methods / discussion section.

Description Where to find?

Methods

Discussion

Does the SR report absolute numbers as well as appropriate summary statistics?

•The review should clearly report the statistical summary and absolute number

The results sectionMainly as a forest plot.

Description Where to find?

Results

Results

Does the SR report on the clinical relevance / importance of the results?

Conclusion/ recommendation section.

Where to find?

Any question???

Thank you