LibGuides: UPSMN Ring: Appraise the Information

Appraise an Article

When selecting an article, you will want to consider its relevance to your question and the strength of its evidence. Below are some questions you might want to ask yourself:

What is the study design used in this article?
Is this an appropriate study design for my question?
Where does this study design fall in the Evidence Pyramid?
Was the study well-designed?
What is the possibility that bias might be affecting the results?
What do the statistics or results really mean?
Are they statistically significant? Clinically significant?
What are the weaknesses of this article or study?
Would the results of this study affect how I might approach the patient?

CASP Checklists
CASP provides checklists to help appraise a variety of different study designs.

Levels of Evidence

Publication types are ranked in evidence pyramids based on the rigor of evidence provided by the research design.

When searching for evidence, be sure to consider what type(s) of publication will have the information you are looking for, as well as where that publication or study type falls within this pyramid.

You want to aim for as high a level of evidence as you can. However, not every topic will have a systematic review available, so you will then need to work your way down.

Levels of Evidence Pyramid

Evidence-Based Medicine: Study Design
This guide from MD Anderson discusses different study designs and provides guidance on which study designs are best to answer different types of questions.

Question Type & Study Design

What type of question you are trying to answer (e.g. therapy, diagnosis, etc.) will directly affect what types of evidence you can expect or hope to find. For example, a therapy question would ideally be answered by a randomized controlled trial. However, it is not very ethical to randomize people to experience a potential harm, so an etiology question may be more appropriately answered by a cohort or case-control study.

When assessing the evidence you are finding, you want to aim for the top of the pyramid, but also consider if that evidence would exist and what type of study would best encompass it.

Question Type	Best Evidence
Therapy	Randomized Controlled Trials
Diagnosis	Diagnostic Validation Studies (compare new & gold standard tests)
Etiology/Harm	Cohort Studies Case-Control Studies
Prognosis	Cohort Studies Case-Control Studies

Understanding Biostatistics

The following resources can help you make sense of the statistics that may appear in your selected article:

JAMA Evidence This link opens in a new window
Includes full content from the second edition of Users’ Guides to the Medical Literature and Rational and Clinical Examination, as well as education guides, a glossary of EBM terms and definitions, calculators, worksheets, and other tools to aid in understanding and applying the medical literature and making clinical diagnoses. This resource is for use only by academic faculty, staff, and students, and is not for use in hospitals or clinics.

Studying a Study and Testing a Test by Richard K. Riegelman
Publication Date: 2020
A package of textbook, interactive exercises, and real research articles designed for use alongside Journal Clubs. It employs a step-by-step framework to help students and residents recognize a meaningful study, identify potential study flaws, and apply solid evidence in clinical decision making.
Epidemiology and Biostatistics by Bryan Kestenbaum
Publication Date: 2018
Concise, fast-paced, intensive introduction to clinical research design for students and clinical research professionals Readers will gain sufficient knowledge to pass the United States Medical Licensing Examination part I section in Epidemiology
Biostatistics and Epidemiology by Sylvia Wassertheil-Smoller; Jordan Smoller
Publication Date: 2015
Since the publication of the first edition, Biostatistics and Epidemiology has attracted loyal readers from across specialty areas in the biomedical community. Not only does this textbook teach foundations of epidemiological design and statistical methods, but it also includes topics applicable to new areas of research. Areas covered in the fourth edition include a new chapter on risk prediction, risk reclassification and evaluation of biomarkers, new material on propensity analyses, and a vastly expanded chapter on genetic epidemiology, which is particularly relevant to those who wish to understand the epidemiological and statistical aspects of scientific articles in this rapidly advancing field. Biostatistics and Epidemiology was written to be accessible for readers without backgrounds in mathematics.