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((CCritical ritical AAppraisal of the ppraisal of the

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• 1. Artikel ini berasal dari peer-reviewed journal Indian J NeurotraumaPublished Online, March 11, 2015

2.Penelitian ini tidak disponsori oleh organisasi manapun yang dapat mempengaruhi desain atau hasil penelitian dan telah melewati penyaringan etik

VALIDITAS

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RELEVANSI

MAKSUD PENELITIANMAKSUD PENELITIAN

• Tujuan :membandingkan outcome pada penanganan kontusio serebri antara ‘burr hole with small craniectomy’ dengan ‘conventional craniotomy’

• 4 kategori klinis mayor:• Terapi• Diagnosis• Etiologi• Prognosis

Clinical category

Description Prefered Study Design

Therapy Tests the effectiveness of a treatment, such as a drug, surgical procedure, or other intervention

Randomized, double-blinded, placebo- controlled 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 presymptomatic stage when applied to a large population

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

Causation Assesses whether sex hormone levels associated with breast cancer risk

Cohort or case-control

Prognosis Determines the outcome of a disease

Longitudinal cohort study

Evaluate the Validity of the Article Based Evaluate the Validity of the Article Based

on Its Intenton Its Intent

• Therapy• Diagnosis• Causation• Prognosis

LevelLevel ofof EvidenceEvidenceLevel

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 case-series

Absolute SpPins and SnNouts††

Level

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-sampleonly

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

Therapy/Prevention, Aetiology/Harm

Prognosis Diagnosis

3a SR (with homogeneity*) of

case-control studies

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

3b Individual Case-Control Study

  Non-consecutive study; or without consistently

applied reference standards

4 Case-series (and poor quality cohort and

case-control studies§)

Case-series (and poor quality

prognostic cohort studies***)

Case-control study, poor or non-

independent reference standard

5 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 RecommendationGrades of Recommendation

A consistent level 1 studies

B consistent level 2 or 3 studies or extrapolations from level 1 studies

C level 4 studies or extrapolations from level 2 or 3 studies

D level 5 evidence or troublingly inconsistent or inconclusive studies of any level