Critical Appraisal Questions

Critical appraisal
Name
Course
Instructor
Date
Article 1
Shin, T. G., Jo, I. J., Choi, D. J., Kang, M. J., Jeon, K., Suh, G. Y., ... & Jeong, Y. K. (2013). The adverse effect of emergency department crowding on compliance with the resuscitation bundle in the management of severe sepsis and septic shock. Crit Care, 17(5), R224.
Use to Rapidly Critically Appraise Case-Control Studies 1. Are the Results of the Study Valid?
a. How were the cases obtained?
Yes
No
Unknown

b. Were appropriate controls selected?

Yes
No
Unknown

c. Were data collection methods the same for the cases and controls?

Yes
No
Unknown


2. What are the Results?
a. Is an estimate of effect given (do the numbers add up)?
Yes
No
Unknown

b. Are there multiple comparisons of data?


Yes
No
Unknown

d. Is there any possibility of bias or confounding?

Yes
No
Unknown

3. Will the Results Help Me in Caring for my Patients?

a. Were the study patients similar to my own?

Yes
No
Unknown

b. How do the results compare with previous studies?
_low compliance with sepsis bundle delays implementation of various bundle elements__________________

c. What are my patients/family’s values and expectations for the outcome?
_improved compliance with sepsis guidelines to improve health outcomes__________________


Use to Rapidly Critically Appraise Evidence-based Clinical Practice Guidelines

CREDIBILITY
1) Who were the guideline developers? __the researchers adopted the Sepsis Campaign guidelines__________________

2) Were the developers representative of key stakeholders in this specialty (interdisciplinary)?
Yes
No
Unknown

3) Who funded the guideline development?
__ Surviving Sepsis Campaign Executive Committee __________________

4) Were any of the guideline developers funded researchers of the reviewed studies?
Yes
No
Unknown

5) Did the team have a valid development strategy?
Yes
No
Unknown

6) Was an explicit (how decisions were made), sensible and impartial process used to identify, select, and combine evidence? Yes No Unknown

7) Did its developers carry out a comprehensive, reproducible literature review within the past 12 months of its publication/revision? Yes No Unknown

8) Were all important options and outcomes considered?
Yes
No
Unknown

9) Is each recommendation in the guideline tagged by the level/strength of evidence upon which it is based and linked with the scientific evidence?
Yes
No
Unknown

10) Do the guidelines make explicit recommendations (reflecting value judgments about outcomes)?
Yes
No
Unknown

11) Has the guideline been subjected to peer review and testing?
Yes
No
Unknown

APPLICABILITY/GENERALIZABILITY

12) Is the intent of use provided (e.g. national, regional, local)?

Yes
No
Unknown

13) Are the recommendations clinically relevant?

Yes
No
Unknown

14) Will the recommendations help me in caring for my patients?
Yes
No
Unknown
15) Are the recommendations practical/feasible (e. g. resources [people and equipment] available)?
Yes
No
Unknown
16) Are the recommendations a major variation from current practice?
Yes
No
Unknown
17) Can the outcomes be measured through standard care? Yes No Unknown


Use to Rapidly Critically Appraise Cohort Studies1. Are the results of the study valid?a. Was there a representative and well defined sample ofpatients at a similar point in the course of the disease?YesNoUnknownb. Was follow up sufficiently long and complete?YesNoUnknownc. Were objective and unbiased outcome criteria used?YesNoUnknownd. Did the analysis adjust for important prognostic risk factorsand confounding variables?YesNoUnknown2. What are the results?a. What is the magnitude of the relationship between predictors(i.e., prognostic indicators) and targeted outcome? Increase in crowding affected compliance with sepsis bundles at 31.9% for low overcrowding and 16.45 for high overcrowding._________________b. How likely is the outcome event(s) in a specified period of time?
The rate of compliance with guidelines cannot be predicted_________________c. How precise are the study estimates?_ At 95% CI________________3. Will the results help me in caring for my patients?a. Were the study patients similar to my own?YesNoUnknownb. Will the results lead directly to selecting or avoiding therapy?YesNoUnknownc. Are the results useful for reassuring or counseling patients?YesNoUnknown
Use to Rapidly Critically Appraise Qualitative Evidence

1) Are the results of the study valid (i.e., trustworthy and credible)?
a) How were study participants chosen?
Used a registry to categorize patients with sepsis shock placed into different crowding categories.___________________
b) How were accuracy and completeness of data assured?
__the researchers ensured there were no missing values after identifying the study participants_________________
c) How plausible/believable are the results?
i) Are implications of the research stated? Yes No Unknown
(1) May new insights increase sensitivity to others’ needs?
Yes No Unknown
(2) May understandings enhance situational competence?
Yes No Unknown
d) What is the effect on the reader?
(1) Are results plausible and believable? Yes No Unknown
(2) Is the reader imaginatively drawn into the experience?
Yes No Unknown
2) What were the results?
a) Does the research approach fit the purpose of the study?
Yes No Unknown
i) How does the researcher identify the study approach?
Yes No Unknown
(1) Are language and concepts consistent with the approach? Yes No Unknown
(2) Are data collection and analysis techniques appropriate? Yes No Unknown
ii) Is the significance/importance of the study explicit?
Yes No Unknown
(1) Does review of the literature support a need for the study? Yes No Unknown
(2) What is the study’s potential contribution? _highlights on the benefits of reducing overcrowding to improve compliance with resuscitation bundle___________________
iii) Is the sampling strategy clear and guided by study needs?
Yes No Unknown
(1) Does the researcher control selection of the sample?
Yes No Unknown
(2) Do sample composition and size reflect study needs?
Yes No Unknown
b) Is the phenomenon (human experience) clearly identified?
i) Are data collection procedures clear?
Yes No Unknown
(1) Are sources and means of verifying data explicit? Yes No Unknown
(2) Are researcher roles and activities explained? Yes No Unknown
ii) Are data analysis procedures described? Yes No Unknown
(1) Does analysis guide direction of sampling Yes No Unknown and when it ends?
(2) Are data management processes described?
Yes No Unknown
c) What are the reported results (description or interpretation)?
i) How are specific findings presented?
_quantitative analysis on the relationship between crowding rates and compliance with sepsis bundle___________________
(1) Is presentation logical, consistent, and easy to follow?
Yes No Unknown
(2) Do quotes fit the findings they are intended to illustrate? Yes No Unknown
ii) How are overall results presented?
The overall occupancy results in the Emergency Department were correlated with compliance rates with bundle elements____________________
(1) Are meanings derived from data described in context?
Yes No Unknown
(2) Does the writing effectively promote understanding?
Yes No Unknown
3) Will the results help me in caring for my patients?
a) Are the results relevant to persons in similar situations?
Yes No Unknown
b) Are the results relevant to patient values and/or circumstances? Yes No Unknown
c) How may the results be applied in clinical practice?
Improving the hospital conditions to reduce overcrowding before emphasizing on the need to adhere to the sepsis bundle____________________

Use to Rapidly Critically Appraise Randomized Clinical Trials (RCTs)

1. Are the results of the study valid?

a. Were the subjects randomly assigned to the experimental and control groups? Yes No Unknown
b. Was random assignment concealed from the individuals who were first enrolling subjects into
the study? Yes No Unknown
c. Were the subjects and providers blind to the study group? Yes No Unknown
d. Were reasons given to explain why subjects did not complete the study? Yes No Unknown
e. Were the follow-up assessments conducted long enough to fully study the effects of the intervention? Yes No Unknown
f. Were the subjects analyzed in the group to which they were randomly assigned? Yes No Unknown
g. Was the control group appropriate? Yes No Unknown
h. Were the instruments used to measure the outcomes valid and reliable? Yes No Unknown
i. Were the subjects in each of the groups similar on demographic and baseline clinical variables? Yes No Unknown
2. What are the results?
a. How large is the intervention or treatment effect
(NNT, NNH, effect size, level of significance)? _unknown _________________
b. How precise is the intervention or treatment (CI)? _95% CI _________________
3. Will the results help me in caring for my patients?
a. Were all clinically important outcomes measured? Yes No Unknown
b. What are the risks and benefits of the treatment? _unknown_________________
c. Is the treatment feasible in my clinical setting? Yes No Unknown
d. What are my patients/family’s values and expectations for the outcome that is trying to be prevented and the treatment itself? _better compliance with sepsis bundle_________________


Rapid Critical Appraisal of Systematic Reviews of Clinical Interventions/Treatments 1. Are the results of the review valid?
a. Are the studies contained in the review randomized controlled trials?
Yes No Unknown

b. Does the review include a detailed description of the search strategy to find all relevant studies?
Yes No Unknown
c. Does the review describe how validity of the individual studies was assessed (e.g., methodological quality, including the use of random assignment to study groups and complete follow-up of the subjects)? Yes No Unknown
d. Were the results consistent across studies?
Yes No Unknown
e. Were individual patient data or aggregate data used in the analysis?
Ye...