Critical appraisal in clinical practice: sometimes irrelevant, occasionally invalid.
A core activity of evidence-based practice is the search for and appraisal of evidence on specific clinical issues. Clinicians vary in their competence in this process; we therefore developed a 16-item checklist for quality of content (relevance and validity) and presentation (useability, attribution, currency and contact details). This was applied to a set of 55 consecutive appraisals conducted by clinicians and posted at a web-based medical journal club site. Questions were well formulated in 51/55 (92%) of the appraisals. However, 22% of appraisals missed the most relevant articles to answer the clinical question. Validity of articles was well appraised, with methodological information and data accurately extracted in 84% and accurate conversion to clinically meaningful summary statistics in 87%. The appraisals were presented in a useable way with appropriate and clear bottom-lines stated in 95%. The weakest link in production of good-quality critical appraisals was identification of relevant articles. This should be a focus for evidence-based medicine and critical appraisal skills.
Coomarasamy
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A
Education Resource Centre, Birmingham Women's Hospital, Metchley Park Road, Birmingham B15 2TG, UK. arricoomar@hotmail.com
Latthe
P
P
Papaioannou
S
S
Publicover
M
M
Gee
H
H
Khan
K S
KS
D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D016247:Information Storage and Retrieval / Q000592:standards*; D020407:Internet / Q000592:standards*; D011361:Professional Competence; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results