CAT

(Critical Appraisal of the Topics)

Screen for Initial Validity and
Relevance
 Published by peer-reviewed journal ( journal of

pediatric Surgery Elsevier Inc.)

 Received 23 November 2015  received in revised
17 June 2016  accepted 20 June 2016  now
available online
 Located at Departement of Pediatric Surgery,
Addenbrooke,s Cambridege University Hospitals NHS
Trust, Cambridge, United Kingdom
This Journal has some advantages and
disadvantages that cause both the validity and
relevance are good
.

Advantages :

 Published by team that have peer review team ( journal of

pediatric Surgery Elsevier Inc.)
 This study was not influenced by the sponsor / specific
organization, and the authors also state that the study was
not related to the financial interest
 If the information of the journal its true, it will enhance our
modality as a surgeon, to diagnosed the incidence of
incisional hernia
Disadvantages :
The limitation of retrospective study is that the journal can
only managed the data for those children with IH who have
had surgical repair, THEREFORE the jornal do not have the
data regarding children who may have had symptoms of IH if
the did not have surgery
Determine the Intent of the Article
 The aim of the study:
 To analyze the incidence and treatment of IH
• Four major clinical categories :
 Therapy
 Diagnosis
 Causation
 Prognosis
 Method of the study:
 Retrospective, from hospital records of all patients
admitted under the pediatric surgeon for IH repair
between January 2008 and October 2014 at
Addenbrooke’s Cambridge University Hospital NHS
Trust, Cambridge, UK
Clinical category Description Prefered Study Design

Therapy Tests the effectiveness of a Randomized, double-

treatment, such as a drug, surgical blinded, placebo-
procedure, or other intervention controlled trial
Diagnosis Measures the validity (is it Cross-sectional survey
dependable?) and reliability (will (comparing the new
the same results be obtained every test with a reference
time?) of a diagnostic test, or standard)
evaluates the effectiveness of a
test in detecting disease at a
presymptomatic stage when
applied to a large population
Causation Assesses whether a substance is
Cohort or case-control
related to the development of an
illness or condition
Prognosis
Determines the outcome of a disease Longitudinal cohort study
Will the results help me in patient care?

Yes
 Level of Evidence
Level Therapy/Prevention, Prognosis Diagnosis
Aetiology/Harm

1a SR (with homogeneity*) of SR (with homogeneity*) of SR (with homogeneity*) of

RCTs inception cohort Level 1 diagnostic studies;
studies; CDR† CDR† with 1b studies from
validated in different different clinical centres
populations

1b Individual RCT (with narrow
Confidence Interval‡)
Individual inception cohort Validating** cohort study with
study with > 80% good††† reference
follow-up; CDR† standards; or CDR† tested
validated in a single within one clinical centre
population

1c All or none§ All or none case-series Absolute SpPins and

SnNouts††
 Level of Evidence

Level Therapy/Prevention, Prognosis Diagnosis

Aetiology/Harm
2a SR (with homogeneity* ) of SR (with homogeneity*) SR (with homogeneity*) of
cohort studies of either retrospective Level >2 diagnostic studies
cohort studies or
untreated control groups
in RCTs
2b Individual cohort study Retrospective cohort Exploratory** cohort study
(including low quality RCT; study or follow-up of with good” “ “ reference
e.g., <80% follow-up) untreated control standards; CDR “ after
patients in an RCT; derivation, or validated only
Derivation of CDR† or on split-sample or databases
validated on split-
sample only
2c "Outcomes" Research; "Outcomes" Research
Ecological studies
Grades of Recommendation

A consistent level 1 studies

B consistent level 2 or 3 studies or

extrapolations from level 1 studies
C level 4 studies or extrapolations from level 2
or 3 studies
D level 5 evidence or troublingly inconsistent or
inconclusive studies of any level