Systematic Review Appraisal Tools

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SYSTEMATIC REVIEW (OF THERAPY) WORKSHEET Citation: Are the results of this systematic review valid? Is this a systematic review of randomised trials? Does it include a methods section that describes: a) finding and including all relevant trials? b) assessing their individual validity? Were the results consistent from study to study? Were the individual patient data used in the analysis (or aggregate data)? Are the valid results of this systematic review important? Translating odds ratios to NN
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  SYSTEMATIC REVIEW (OF THERAPY) WORKSHEETCitation:Are the results of this systematic review valid? Is this a systematic review of randomisedtrials?Does it include a methods section thatdescribes:a)finding and including all relevant trials? b)assessing their individual validity?Were the results consistent from study tostudy?Were the individual patient data used in theanalysis (or aggregate data)? Are the valid results of this systematic review important?Translating odds ratios to NNTs: The numbers in the body of the tables are the NNTs for the corresponding odds ratio atthat particular patient’s expected event rate (PEER). 1.When the odds ratio (OR) < 1 This table applies when a bad outcome is prevented by therapy.OR <’sexpectedevent rate(PEER)0.05 2.09 a 104695241 b 0.10 11054362721 0.20 6130201411 0.30 462214108 0.40 40191297 0.50 38181186 0.70 44201396 0.90 101 c 46271812 d   a The relative risk reduction (RRR) here is 10%  b The RRR here is 49%  c For any OR, NNT is lowest when PEER = 0.50  d The RRR here is 9%  2.When the odds ratio (OR) > 1 This table applies both when a good outcome is increased by therapy and when aside-effect is caused by therapy.OR >’sexpectedevent rate(PEER)0.05 212106715443 0.10 11257382923 0.20 6433221714 0.30 4925171311 0.40 4323161210 0.50 4222151210 0.70 5127191513 0.90 12166473832 Can you apply this valid, important evidence from a systematic review in caring foryour patient? Do these results apply to our patient?Is your patient so different from those inthe study that its results cannot apply?Is the treatment feasible in your setting?What are your patient’s potential benefits and harms from the therapy? Method I: In the OR tables above, find theintersection of the closest odds ratio fromthe systematic review and your patient’sexpected event rate (PEER) Method II: To calculate the NNT from anyOR and PEER: ( ){ } )1()1( 11 OR PEER PEEROR PEER NNT  −××− −×−= Are your patient’s values and preferences satisfied by the regimen and its consequences?Do you and you patient have a clear assessment of their values and preferences?Are they met by this regimen and itsconsequences?  Should you believe apparent qualitative differences in the efficacy of therapy insome subgroups of patients?—Only if you can say ‘yes’ to all of the following: Do they really make biologic and clincalsense?Is the qualitative difference both clinically(beneficial for some but useless or harmfulfor others) and statistically significant?Was this difference hypothesised beforethe study began (rather than the product of dredging the data), and has it beenconfirmed in other, independent studies?Was this one of just a few subgroupanalyses carried out in this study? Additional notes:
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