Oxford Centre for Evidence-based Medicine – Levels of Evidence (March 2009)

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1、OxfordCentreforEvidence-basedMedicine–LevelsofEvidence(March2009)Whatarewetodowhentheirresistibleforceoftheneedtoofferclinicaladvicemeetswiththeimmovableobjectofflawedevidence?Allwecandoisourbest:givetheadvice,butalerttheadviseestotheflawsintheevidenceonwhichitisbased.The

2、CEBM‘LevelsofEvidence1′documentsetsoutoneapproachtosystematisingthisprocessfordifferentquestiontypes.(Fordefinitionsoftermsusedseeourglossary)LevelTherapy/Prevention,Aetiology/HarmPrognosisDiagnosisDifferentialdiagnosis/symptomprevalencestudyEconomicanddecisionanalyses1aS

3、R(withhomogeneity*)ofRCTsSR(withhomogeneity*)ofinceptioncohortstudies;CDR”?validatedindifferentpopulationsSR(withhomogeneity*)ofLevel1diagnosticstudies;CDR”?with1bstudiesfromdifferentclinicalcentresSR(withhomogeneity*)ofprospectivecohortstudiesSR(withhomogeneity*)ofLevel1

4、economicstudies1bIndividualRCT(withnarrowConfidenceInterval”?)Individualinceptioncohortstudywith>80%follow-up;CDR”?validatedinasinglepopulationValidating**cohortstudywithgood”?”?”?referencestandards;orCDR”?testedwithinoneclinicalcentreProspectivecohortstudywithgoodfollow-

5、up****Analysisbasedonclinicallysensiblecostsoralternatives;systematicreview(s)oftheevidence;andincludingmulti-waysensitivityanalyses1cAllornone§Allornonecase-seriesAbsoluteSpPinsandSnNouts”?“Allornonecase-seriesAbsolutebetter-valueorworse-valueanalyses”?”?”?“2aSR(withhomo

6、geneity*)ofcohortstudiesSR(withhomogeneity*)ofeitherretrospectivecohortstudiesoruntreatedcontrolgroupsinRCTsSR(withhomogeneity*)ofLevel>2diagnosticstudiesSR(withhomogeneity*)of2bandbetterstudiesSR(withhomogeneity*)ofLevel>2economicstudies2bIndividualcohortstudy(includingl

7、owqualityRCT;e.g.,<80%follow-up)Retrospectivecohortstudyorfollow-upofuntreatedcontrolpatientsinanRCT;DerivationofCDR”?orvalidatedonsplit-sample§§§onlyExploratory**cohortstudywithgood”?”?”?referencestandards;CDR”?afterderivation,orvalidatedonlyonsplit-sample§§§ordatabasesR

8、etrospectivecohortstudy,orpoorfollow-upAnalysisbasedonclinicallysensiblecostsoralternatives;limi