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Selecting and Appraising Studies for a Systematic Review

Maureen O. Meade, MD, FRCPC, MSc; and W. Scott Richardson, MD
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From the University of Toronto, Toronto, Ontario, Canada; and the University of Rochester School of Medicine and Dentistry, Rochester, New York. Acknowledgment: The authors thank the clinical reviewer, Norman J. Wilder. Requests for Reprints: Deborah Cook, MD, MSc, Department of Medicine, Division of Critical Care, St. Joseph's Hospital, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada. Current Author Addresses: Dr. Meade: The Wellesley-Central Hospital, Room 244, Jones Building, 150 Wellesley Street East, Toronto, Ontario M4Y 1J3, Canada.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;127(7):531-537. doi:10.7326/0003-4819-127-7-199710010-00005
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After thoroughly searching the potentially relevant literature for a systematic review, reviewers face the sequential tasks of selecting studies for inclusion and appraising these studies.Methodical, impartial, and reliable strategies are necessary for these two tasks because systematic reviews are retrospective exercises and are therefore prone to both bias and random error. To plan for study selection, reviewers begin with a focused clinical question and choose selection criteria that reflect this question. A detailed selection protocol that specifies the study designs and publication status of articles to be included is often helpful. Selection criteria are itemized on customized forms and are used to examine each potentially relevant primary study, usually by two different reviewers. In planning the critical appraisal of included studies, reviewers decide which clinical and methodologic study features require documentation. After choosing methods for evaluating study quality, reviewers construct customized appraisal forms and an explicit protocol for the actual evaluation. Some of the techniques commonly used to minimize the potential for error in study appraisal include duplicate, independent examination; blinding to study results and other identifying features of each article; and correspondence with study authors to clarify issues.

Ultimately, primary studies should be selected, appraised, and reported in sufficient detail to allow readers to judge the applicability of the review to clinical practice and to clarify the strength of the inferences that can be drawn from the review.


Grahic Jump Location
Figure 1.
Example of a form that might be developed for the selection of studies for a systematic review evaluating the efficacy of β-blockers for secondary prevention of variceal bleeding.
Grahic Jump Location




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