Critical Appraisal Worksheet for Diagnosis

Critical Appraisal Worksheet : Diagnostic Test

Department [ ] 1. Med[ ] 2. Pediatrics[ ] 3. Surgery[ ] 4. OB-GYN[ ] 5. EYE [ ] 6. ENT

[ ] 7. Radio[ ] 8. Ortho.[ ] 9. Anaes.[ ] 10. Rehab. [ ] 11. Patho [ ] 12. Forensic

Activity: [ ] 1. Journal Club[ ] 2. Interesting Case[ ] 3. Others………………….……………..
Date(DD/MM/YY): [ ] [ ] / [ ] [ ] / [ ] [ ]

Main Appraiser:[ ] 1. Resident ปีที่……… [ ] 2.แพทย์ใช้ทุนปีที่……….[ ] 3. อื่นๆ………………………………………..
Name of Appraiser/Staff ………………………………………………………………………………………………………………………..
Scenario:…………………………………………………………..…………………….……………………………………..……..

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Four-part clinical question:

Patient/Health problem:……………………………………………………………………………………..…..………………
Intervention:…………………………………………………………………………………………………..…..………………
Comparison:……………………………………………………………………………………………...……….…………......
Outcome:……………………………………………………………………………………………….…………...………….…
Clinical Question:………….………………………………………………………………………………………………………..
Search Strategies:

Search terms & Syntax ………………………………………………………………..………………………………………

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Databases ………….…….……………………………………………………………………..………………………………

Date of Search ……………………………………………………………………………………………………………………
Number of Retrieved Articles: ………………………………………………………………………………………………….

Article to be appraised :…….……………………….……………………………………………………………………………

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Method of study:

[ ] 1. Systematic Review[ ] 2. Clinical Trial (experimental study) [ ] 3. Cohort study[ ] 4. Case-control [ ] 5. Cross-sectional study [ ] 6. Descriptive study [ ] 5. Others …….……………………….……

I. Study validity:

Was there a comparison with an appropriate reference ("gold") standard of diagnosis? / [ ] Yes [ ] No [ ] Can’t tell
Note……………………………………………………………………
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Could the results of the test of interest have been influenced by the results of the reference standard? Independent & blinding interpretation? / [ ] Yes [ ] No [ ] Can’t tell
Note……………………………………………………………………
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Was the diagnostic test evaluated in an appropriate spectrum of patients (like those in whom it would be used in practice)? / [ ] Yes [ ] No [ ] Can’t tell
Note……………………………………………………………………
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Was the reference standard applied regardless of the diagnostic test result? / [ ] Yes [ ] No [ ] Can’t tell
Note……………………………………………………………………
Was the methods for performing the test described in sufficient detail? / [ ] Yes [ ] No [ ] Can’t tell
Note……………………………………………………………………
Score of validity (0-10)
Overall validity? / [ ] Accept [ ] Reject

II. Are the valid results of this diagnostic study important?

Target Disorder / Totals
Present / Absent
Diagnostic test result / Positive / a / b / a+b
Negative / c / d / c+d
Totals / a+c / b+d / a+b+c+d
Point Estimate / 95%CI / Not available
Sensitivity = a/(a+c)
Specificity = d/(b+d)
Likelihood Ratio for a positive test result = LR+=sens/(1-spec)
Likelihood Ratio for a negative test result=LR-=(1-sens)/spec
Positive Predictive Value = a/(a+b)
Negative Predictive Value = d/(c+d)
Pre-test Probability = Prevalence = (a+c)/(a+b+c+d)
Diagnostic Accuracy = (a+d)/(a+b+c+d)

Note ……………………………………………………………………………………………………………………

III. Applicability and Limitations:

Is the diagnostic test available, affordable, accurate, and reliable in your setting? / [ ] Yes [ ] No [ ] Can’t tell
Note……………………………………………………………………
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Can you generate a clinically sensible estimate of your patient's pre-test probability (from practical data, from personal experience, from the report itself, or from clinical speculation)? / [ ] Yes [ ] No [ ] Can’t tell
Note……………………………………………………………………
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Will the resulting post-test probabilities affect your management and help your patient? / [ ] Yes [ ] No [ ] Can’t tell
Note……………………………………………………………………
Would the consequences of the test help your patient? / [ ] Yes [ ] No [ ] Can’t tell
Note……………………………………………………………………

Clinical Bottom Line of the Article……………………………………………………………………………………

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Resolution of the Scenario ……………………………………………………………………………………………

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Comments .…………………………………………………………………………………………

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คณะกรรมการเวชศาสตร์เชิงประจักษ์_สิงหาคม2548 ปรับปรุงจากJAMA 1994;271:389-91 & 703-7และCritical Appraisal Skills Programme (CASP), Public Health Resource Unit, Institute of Health Science, Oxford.