This document provides guidance on appraising a systematic review using a checklist. It addresses key questions like whether the systematic review had a clear research question, performed a comprehensive literature search, explicitly stated inclusion/exclusion criteria, assessed study quality, stated how results were combined statistically, reported absolute numbers and summary statistics, and discussed clinical relevance. The document notes that important details on these aspects can typically be found in sections like the Methods, Results, and Conclusion sections of a systematic review. It aims to help reviewers appraise important methodological aspects of a systematic review.

1. Appraisal of a systematic reviewAppraisal of a systematic review
using a checklist: Notes andusing a checklist: Notes and
ExampleExample
Nouran Hamza, BSc Pharm, MSc, DPH
Biostatistician

2. Vasopressors for the Treatment of Septic
Shock: Systematic Review and Meta-
Analysis
Tomer Avni, Adi Lador, Shaul Lev, Leonard Leibovici, Mical Paul, Alon Grossman
The content of this presentation relates ONLY
to SRs of RCTs with meta-analysis

3. What question (PICO) did the systematic
review address?
•Problem/Patient/Population,
•Intervention/Indicator,
•Comparison
•Outcome,
•and(optional) Time element or Type of
Study
The Title, Abstract or final paragraph of the
Introduction
Description Where to find?

4. Abstract
Final paragraph in the
introduction
Title

5. Does the SR perform and report a
comprehensive and reproducible literature
search?
•The starting point for comprehensive search for all
relevant studies is the major bibliographic databases (e.g.,
Medline, Cochrane, EMBASE, etc)
• Shall include a search of reference lists from relevant
studies, and contact with experts, particularly to inquire
about unpublished studies.
• The search should not be limited to English language only.
• The search strategy should include both MESH terms and
text words.
The method section
Results
Look for a flow diagram identifying the
literature search
Description
Where to find?

6. Method

7. Results:

8. Flow chart:

9. Does the methods section explicitly state
the basis for the inclusion or exclusion of
primary studies?
•The inclusion and exclusion of studies in a
systematic review should be clearly defined
•. The eligibility criteria used shall specify the
patients, interventions or exposures and
outcomes of interest.
• The type of study design will also be a
master component of the eligibility criteria.
The Methods section should
describe the inclusion and
exclusion criteria in details
Description
Where to find?

10. Methods:

11. The author
had also
included
supported
file :

12. Does the SR assess the methodological
quality of primary studies, and take these
into account?
•The Jadad score is a well recognised and
often reported quality score
•A review may use other categorisations of
methodological quality. However, it should be
clearly explain with justification for the
calculations
•Other methods might also be acceptable
(e.g., randomization, blinding and
completeness of follow-up)
The Methods section should
describe the assessment of
quality and the criteria used.
The Results section should
provide information on the
quality of the individual studies.
Description Where to find?

13. Methods:

14. Does the SR state how the results are
combined statistically?
•The review should clearly states the
statistical procedure
The methods / discussion
section.
Description Where to find?

15. Methods
Discussion

16. Does the SR report absolute numbers as
well as appropriate summary statistics?
•The review should clearly report the
statistical summary and absolute number
The results section
Mainly as a forest plot.
Description Where to find?

17. Results

18. Results

19. Does the SR report on the clinical
relevance / importance of the results?
Conclusion/
recommendation
section.
Where to find?

20. Any question???
Thank you