Research critical appraisal contribution guide
Joshua Yu March 17, 2025
Appraisal structure
Critical appraisal of primary or secondary literature will have two major sections:
- A quick and concise need-to-know summary
- A more detailed breakdown of the paper and assessment of quality of the evidence
Quick facts
This section should not be longer than half a page at most. It is meant as a quick glance-over refresher about what the take-home points were. Use highlights to emphasize the key information (ie. the primary outcomes of interest, key exclusions, etc.).
- What is the main clinical question?
- What is the study type?
- What is the population?
- What was the intervention? The therapeutic, diagnostic, or other intervention under investigation (e.g. the experimental intervention, or in observational studies the exposure factor)
- What was the comparison/control (if available)?
- What was the outcome(s)?
- What is the bottom line?
- Quality of evidence (AMSTAR 2 for reviews, RoB-2 for randomized trials primary outcomes)
Examples
From the SYGMA2 trial (primary evidence):
| Clinical Question | Is PRN budesonide–formoterol noninferior to daily maintenance budesonide therapy in reducing severe asthma exacerbations for mild asthma? | ||||||||||||||
| Study Type | 52 week double-blind, randomized, multi-center, phase 3, non-inferiority trial | ||||||||||||||
| Population | 4176 patients with mild persistent asthma (≥12 years) were analyzed, including those with previously controlled and uncontrolled symptoms on minimal therapy. | ||||||||||||||
| Intervention | Twice-daily placebo + PRN budesonide–formoterol (200μg/6μg). | ||||||||||||||
| Comparison | Regular BID budesonide (200μg) + as-needed terbutaline (0.5mg). | ||||||||||||||
| Outcomes | At 52 weeks, the PRN budesonide–formoterol group had an annualized rate of severe exacerbations of 0.11 events/patient-year compared to 0.12 events/patient-year in the budesonide group (RR 0.97; upper one-sided 95% CI, 1.16). ACQ-5 score improved by 0.35 in the as-needed group versus 0.46 in the maintenance group (Δ0.11 units; 95% CI, 0.07 to 0.15; p<0.001). Median daily inhaled glucocorticoid exposure in the as-needed group was 66μg vs 267μg in the maintenance group. | ||||||||||||||
| Bottom Line | For mild asthma, PRN budesonide–formoterol was noninferior to daily budesonide in preventing severe exacerbations, with a relatively smaller improvement in ACQ-5 and much less overall steroid exposure. | ||||||||||||||
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The more detailed review
See the page for the SYGMA2 trial for an example:
- Metadata
- Publish year
- Journal
- Funded by
- Authors:
- Primary: list
- Reviewers: list
- Editor: list
- What's the clinical question?
- PICO (in more depth)
- Study design (will depend on if primary vs secondary evidence)
- Results
- Limitations
- Conclusion
- Study quality
Study quality
ROB-2 -- for randomized trials
See here for the original tool, and here for easier to navigate tool that Josh built.