Lifting up the hood of REBEL EM to discuss how we critically appraise the literature…a 12 step tweetorial
#FOAMed #FOAMcc #MedTwitter #MedEd #EBM
#FOAMed #FOAMcc #MedTwitter #MedEd #EBM
Prior Evidence
-Have to go back and look at prior evidence (can’t evaluate studies in a bubble)
-What is the prior evidence
-What was good and/or bad about the prior evidence
-Have to go back and look at prior evidence (can’t evaluate studies in a bubble)
-What is the prior evidence
-What was good and/or bad about the prior evidence
Design
-What type of study is this?
-Observational: Can find association but not causation
-RCT: Gold standard
-Meta: Results only as good as the individual studies
-What type of study is this?
-Observational: Can find association but not causation
-RCT: Gold standard
-Meta: Results only as good as the individual studies
Setting
-What setting did the study take place in (Is this similar to the type of setting you work in)
-Number of places: single center or multicenter
-Location: Prehospital, ED, ICU, etc…
-What setting did the study take place in (Is this similar to the type of setting you work in)
-Number of places: single center or multicenter
-Location: Prehospital, ED, ICU, etc…
Outcomes
-POO: Patient oriented outcome
-LOO: Lab oriented outcome
-MOO: Monitor oriented outcome
-Be careful with surrogate outcomes
-POO: Patient oriented outcome
-LOO: Lab oriented outcome
-MOO: Monitor oriented outcome
-Be careful with surrogate outcomes
Intervention (and Comparison)
-What is the intervention
-What is the control
-What is the intervention
-What is the control
Inclusion
-What type of patients were included in the study
-This is who the results apply to
-What type of patients were included in the study
-This is who the results apply to
Exclusion
-What type of patients were excluded from the study
-Results should not be applied to these patients
-What type of patients were excluded from the study
-Results should not be applied to these patients
Results
-Studies typically powered for primary outcome
-Secondary outcomes are hypothesis generating
-Also pay attention to adverse event
-Studies typically powered for primary outcome
-Secondary outcomes are hypothesis generating
-Also pay attention to adverse event
Strengths
-Methods
-Stats
-Population
-Methods
-Stats
-Population
Limitations
-Methods
-Stats
-Other issues
-Methods
-Stats
-Other issues
Discussion
-Are baseline characteristics of two groups balanced
-Interesting facts
-Commentary
-Are baseline characteristics of two groups balanced
-Interesting facts
-Commentary
The Bottom Line
-Relevant evidence
-Clinical judgement
-Patient values
-How should or shouldn’t this trial affect practice
-Relevant evidence
-Clinical judgement
-Patient values
-How should or shouldn’t this trial affect practice
Putting it all together...this is how you critically appraise the literature like a REBEL
#FOAMed #FOAMcc #MedTwitter #MedEd #EBM
#FOAMed #FOAMcc #MedTwitter #MedEd #EBM
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