JRSM > Volume 94, Number 11 > Pp. 573-577

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Critical appraisal in clinical practice: sometimes irrelevant, occasionally invalid

Aravinthan Coomarasamy MRCOG   Pallavi Latthe MRCOG   Spyros Papaioannou MRCOG   Mary Publicover Harry Gee FRCOG     Khalid S Khan MRCOG  

Education Resource Centre, Birmingham Women's Hospital, Metchley Park Road, Birmingham B15 2TG, UK

Correspondence to: Dr A Coomarasamy E-mail: arricoomar{at}hotmail.com

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.

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