Critical appraisal refers to a set of skills for assessing the validity of sources of information, and especially of research reports measuring benefits and harms of health interventions. This assessment involves judgment about both the quality of the work that was done and its application to specific circumstances. Critical appraisal skills are important for all clinicians, policy makers, administrators, researchers, educators and consumers.
"Online source" indicates that the resource is available online without charge. A cost-free registration may be required for access to some items with this designation.
Tutorials, tools, and checklists
About critical appraisal
Toward better understanding of harms of interventions
Systematic reviews on critical appraisal
Core topics in evidence-based medicine, JAMAevidence, Journal of the American Medical Association.
Critical appraisal, Centre for Evidence Based Medicine.
Critical appraisal of intervention studies, National Collaborating Centre for Methods and Tools.
Critical Appraisal Skills Programme (CASP), Solutions for Public Health, UK National Health Service.
(handouts for developing and applying critical appraisal skills)
Critical appraisal tools, International Centre for Allied Health Evidence, Division of Health Sciences, University of Southern Australia.
Critically appraised topics tool (CATmaker), Centre for Evidenced Based Medicine, University of Oxford.
Discern online: quality criteria for consumer health information, Institute of Health Sciences, University of Oxford.
(tool and other resources for assessing consumer health information)
Greenhalgh T. How to read a paper: the basics of evidence based medicine, 4th ed. London: BMJ Books, 2010.
Guyatt G, Rennie D, Meade M, Cook D. Users’ guides to the medical literature: a manual for evidence-based clinical practice, 2nd ed. New York: McGraw-Hill, 2008.
Guyatt G, Rennie D, Meade M, Cook D. Users’ guides to the medical literature: essentials of evidence-based clinical practice, 2nd ed. New York: McGraw-Hill, 2008.
Tips and tricks for understanding and using systematic reviews. Regular column in: Evidence-Based Child Health: A Cochrane Review Journal.
Altman DG, Bland JM. Statistical notes: absence of evidence is not evidence of absence. BMJ. 1995;311(7003):485.
Barratt A, Wyer PC, Hatala R, McGinn T, Dans AL, Keitz S, Moyer V, Guyatt G, for the Evidence-Based Medicine Teaching Tips Working Group. Tips for learners of evidence-based medicine: 1. relative risk reduction, absolute risk reduction and number needed to treat. CMAJ. 2004;171(4):353-8.
Chalmers I, Matthews R. What are the implications of optimism bias in clinical research? Lancet. 2006;367(9509):449-50.
Glasziou P, Vandenbroucke J, Chalmers I. Assessing the quality of research. BMJ. 2004;328(7430):39-41.
Hatala R, Keitz S, Wyer P, Gordon Guyatt, for the Evidence-Based Medicine Teaching Tips Working Group. Tips for learners of evidence-based medicine: 4. assessing heterogeneity of primary studies in systematic reviews and whether to combine their results. CMAJ. 2005;172(5):661-5.
Lewis SC, Warlow CP. How to spot bias and other potential problems in randomised controlled trials. J Neurol Neurosurg Psychiatry. 2004;75(2):181-7.
McGinn T, Wyer PC, Newman TB, Keitz S, Leipzip R, Guyatt G, for the Evidence-Based Medicine Teaching Tips Working Group. Tips for learners of evidence-based medicine: 3. measures of observer variability (kappa statistic). CMAJ. 2004;171(11):1369-73.
Montori VM, Kleinbart J, Newman TB, Keitz S, Wyer PC, Moyer V, Guyatt G, for the Evidence-Based Medicine Teaching Tips Working Group. Tips for learners of evidence-based medicine: 2. measures of precision (confidence intervals). CMAJ. 2004:171(6):611-5.
Thacker SB, Stroup DF, Peterson HB. Meta-analysis for the practicing obstetrician-gynecologist. Clin Obstet Gynecol. 41(2):275-81.
Williams JK. Understanding evidence-based medicine: a primer. Am J Obstet Gynecol. 2001;185(2):275-8.
Chou R, Helfand M. Challenges in systematic reviews that assess treatment harms. Ann Int Med. 2005;142(12 part 2):1090-9.
Chou R, Aronson N, Atkins D, Ismaila AS, Santaguida P, Smith DH, Whitlock E, Wilt T, Moher D. AHRQ Series Paper 4: Assessing harms when comparing medical interventions: AHRQ and the Effective Health Care Program (EHCP). Journal Clin Epidemiol. 2010; 63(5):502-512.
Cochrane Adverse Effects Methods Group.
Cuervo LG, Clarke M. Balancing benefits and harms in health care. BMJ. 2003;327(7406):65-66.
Golder SP, Loke YK, McIntosh HM. Room for Improvement? A survey of the methods used in systematic reviews of adverse effects. BMC Med Res Methodol. 2006;6:3.
Herxheimer A. Communicating with patients about risks and harms. PLoS Med. 2005; 2(2):e42.
Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions 5.0.2 [updated September 2009]; Chapter 14: Adverse effects.
Ioannidis JPA, Evans SJW, Gřtzsche PC, O'Neill RT, Altman DG, Schulz K, Moher D, for the CONSORT Group. Better reporting of harms in randomized trials: an extension of the CONSORT Statement. Ann Int Med. 2004;141(10):781-8.
(Online Source, with appendices)
Ioannidis JPA, Lau J. Completeness of safety reporting in randomized trials: an evaluation of 7 medical areas. JAMA. 2001;285(4):437-43.
McIntosh HM, Woolacott NF, Bagnall A-M. Assessing harmful effects in systematic reviews. BMC Medical Res Methodol. 2004;4:19.
Papanikolaou PN, Ioannidis JPA. Availability of large-scale evidence on specific harms from systematic review of randomized trials. Am J Med. 2004;117(8):582-9.
Hyde C, Parkes J, Deeks J, Milne R. Systematic review of effectiveness of teaching critical appraisal. Oxford: ICRF/NHS Centre for Statistics in Medicine, Institute of Health Sciences, August 2000.
Katrak P, Bialocerkowski AE, Massy-Westropp N, Saravana Kumar VS, Grimmer KA. A systematic review of the content of critical appraisal tools. BMC Med Res Methodol. 2004;4:22.
Norman GR, Shannon SI. Effectiveness of instruction in critical appraisal (evidence-based medicine): a critical appraisal. CMAJ. 1998;1582177-81.
Parkes J, Hyde C, Deeks J, Milne R. Teaching critical appraisal skills in health care settings. Cochrane Database of Syst Rev. 2010, Issue 1.
Taylor R, Reeves B, Ewings P, Binns S, Keast J, Mears R. A systematic review of the effectiveness of critical appraisal skills training for clinicians. Med Educ. 2000;34(2):120-5.
West S, King V, Carey TS, Lohr KN, McKoy N, Sutton SF, Lux L. Systems to rate the strength of scientific evidence. Rockville, MD: Agency for Healthcare Research and Quality, April 2002. (Evidence Report/Technology Assessment 47.)
(Online Source, PDF)
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