For test/screening evaluation:
- Did participating patients present a diagnostic dilemma? Did investigators compare the test to an appropriate, independent reference standard? Were those interpreting the test and reference standard blind to the other results? Did investigators perform the same reference standard to all patients regardless of the results of the test under investigation?
- What likelihood ratios were associated with the range of possible test results?
- Will the reproducibility of the test result and its interpretation be satisfactory in my clinical setting? Are the study results applicable to the patients in my practice? Will the test results to the patients in my practice? Will the test results change my management strategy? Will patients be better off as a result of the test?
For differential diagnosis:
- What were the diagnoses and their probabilities? How precise were estimates of disease probability?
- Are the study patients and clinical setting similar to mine? Is it unlikely that disease possibilities or probabilities have changed?
- Was the sample of patients representative? Were the patients sufficiently homogeneous with respect to prognostic risk? Was follow-up sufficiently complete? Were outcome criteria objective and unbiased?
- How likely are the outcomes over time? How precise are the estimates of likelihood?
- Were the study patients and their management similar to those in your practice? Was the followup sufficiently long? Can you use the results in the management of patients in your practice?
- Are the groups balanced at the beginning? Throughout the study? At the end? Were patients randomized and was the allocation concealed?
- What is the size of the effect? What is the precision of the effect?
- To what extent do the outcomes of the study match those of my patient? Are the benefits worth the harms and costs?
- Were patients similar for prognostic factors known to associated with the outcome, or did statistical adjust level the playing field? Were the circumstances and method for detecting the outcome similar? Was the follow-up sufficiently complete?
- How strong is the association between exposure and outcome? How precise was the estimate of risk?
- Were the study patients similar to the patient(s) in my practice? Was follow-up sufficiently long? Is the exposure similar to what might risk occur in my patient? What is the magnitude of the risk? Are there any benefits that are known to be associated with exposure?
- Were patients similar for prognostic factors known to associated with the outcome, or did statistical adjust level the playing field? Were the circumstances and method for detecting the outcome similar? Was the follow-up sufficiently complete?
- Were the results similar from study to study? What are the overall results of the review? How precise were the results?
- Were all patient-important outcomes considered? Are any postulated subgroup effects credible? What is the overall quality of the evidence? Are the benefits worth the costs and potential risks?
