11 questions to help you make sense of descriptive/cross-sectional studies How to use this appraisal tool Three broad issues

need to be considered when appraising the report of a descriptive/ cross-sectional study (e.g., a study that collects data on individuals at one time point using a survey or review of medical charts): Are the results of the study valid? What are the results? Will the results help locally? The 11 uestions on the following pages are designed to help you thin! about these issues systematically. The first two uestions are screening uestions and can be answered uic!ly. "f the answer to both is #yes$, it is worth proceeding with the remaining uestions. %ou are as!ed to record a #yes$, #no$ or #can&t tell$ to most of the uestions. ' number of italici(ed prompts are given after each uestion. These are designed to remind you why the uestion is important. )ecord your reasons for your answers in the spaces provided. These uestions are adapted from *uyatt *+, ,ac!ett -., and /oo! -0, 1sers& guides to the medical literature. "". +ow to use an article about therapy or prevention. JAMA 12234 567 (51): 5829-5:71 and JAMA 122;4 561(1): 82-:3 < =ilton >eynes ?rimary /are Trust 5775. 'll rights reserved. Screening uestions %es /an&t tell
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1! "id the study address a clearly focused issue? HINT: A question can be focused in terms of: the population(s) studied the health measure(s) studied (e. .! ris" factor! pre#enti#e beha#ior! outcome) #! "id the authors use an appropriate method to answer their question? HINT: $onsider - Is a descripti#e%cross&sectional stud' an appropriate (a' of ans(erin the question) - *id it address the stud' question)

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$! Were the su%&ects recruited in an accepta%le way? HINT: +e are loo"in for selection bias (hich mi ht compromise the enerali,abilit' of the findin s: & +as the sample representati#e of a defined population) & +as e#er'bod' included (ho should ha#e been included) '! Were the measures accurately measured to reduce %ias? HINT: +e are loo"in for measurement or classification bias: & *id the' use sub-ecti#e or ob-ecti#e measurements) & *o the measures trul' reflect (hat 'ou (ant them to (ha#e the' been #alidated)) (! Were the data collected in a way that addressed the research issue? $onsider: if the settin for data collection (as -ustified if it is clear ho( data (ere collected (e. .! inter#ie(! questionnaire! chart re#ie() if the researcher has -ustified the methods chosen if the researcher has made the methods e.plicit (e. . for inter#ie( method! is there an indication of ho( inter#ie(s (ere conducted))

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)! "id the study have enough participants to %es minimi*e the play of chance? $onsider: if the result is precise enou h to ma"e a decision if there is a po(er calculation. This (ill estimate ho( man' sub-ects are needed to produce a reliable estimate of the measure(s) of interest.

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+! How are the results presented and what is %es the main result? $onsider: if! for e.ample! the results are presented as a proportion of people e.periencin an outcome! such as ris"s! or as a measurement! such as mean or median differences! or as sur#i#al cur#es and ha,ards ho( lar e this si,e of result is and ho( meanin ful it is ho( 'ou (ould sum up the bottom&line result of the trial in one sentence ,! Was the data analysis sufficiently rigorous? %es $onsider: if there is an in&depth description of the anal'sis process if sufficient data are presented to support the findin s -! .s there a clear statement of findings? %es $onsider: if the findin s are e.plicit if there is adequate discussion of the e#idence both for and a ainst the researchers/ ar uments if the researcher ha#e discussed the credibilit' of their findin s if the findin s are discussed in relation to the ori inal research questions 1/! 0an the results %e applied to the local population? HINT: $onsider (hether - The sub-ects co#ered in the stud' could be sufficientl' different from 'our population to cause concern. - 0our local settin is li"el' to differ much from that of the stud' %es

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11! How valua%le is the research? $onsider: if the researcher discusses the contribution the stud' ma"es to e.istin "no(led e (e. . do the' consider the findin s in relation to current practice or polic'! or rele#ant research&based literature)) if the researchers ha#e discussed (hether or ho( the findin s can be transferred to other populations

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