Critical Appraisal

Key to the practice of EBM is that critical appraisal issues must arise from patient problems. Most patient problems fall into one or more of the following categories:

• Therapy
• Diagnostic Tests
• Prognosis
• Harm (etiology, association, risk, exposure, etc.)
• Cost-effectiveness

Since 1992, the EBM working group from McMaster University has published several "How To..." articles on critical appraisal of articles about the above categories. This text is merely a brief overview, and the reader should refer to the JAMA "Users' Guides to the Medical Literature" series cited at the end of this section.

Critical Appraisal of any article has four basic parts.

What is the clinical QUESTION?

Are the results VALID?

What are the RESULTS?

Are the results APPLICABLE to my patients?

Annotated JAMA User's Guides

1. How to Use an Article on Therapy
2. How to Use an Article About a Diagnostic Test
3. How to Use an Article About Harm
4. How to Use an Article About Prognosis
5. How to Use an Overview
6. How to Use a Clinical Decision Analysis
7. How to Use a Clinical Practice Guideline
8. A Method for Grading Health Care Recommendations
9. How to Use an Article Reporting Variations in the Outcomes of Health Services
10. How to Use an Article About a clinical Utilization Review