make sense of a Systematic Review

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CASP Checklist: 10 questions to help you make sense of a Systematic Review
How to use this appraisal tool: Three broad issues need to be considered when appraising a
systematic review study:
Are the results of the study valid? (Section A)
What are the results? (Section B)
Will the results help locally? (Section C)
The 10 questions on the following pages are designed to help you think about these issues
systematically. The first two questions are screening questions and can be answered quickly.
If the answer to both is “yes”, it is worth proceeding with the remaining questions. There is
some degree of overlap between the questions, you are asked to record a “yes”, “no” or
“can’t tell” to most of the questions. A number of italicised prompts are given after each
question. These are designed to remind you why the question is important. Record your
reasons for your answers in the spaces provided.
About: These checklists were designed to be used as educational pedagogic tools, as part of a
workshop setting, therefore we do not suggest a scoring system. The core CASP checklists
(randomised controlled trial & systematic review) were based on JAMA ‘Users’ guides to the
medical literature 1994 (adapted from Guyatt GH, Sackett DL, and Cook DJ), and piloted with
health care practitioners.
For each new checklist, a group of experts were assembled to develop and pilot the checklist
and the workshop format with which it would be used. Over the years overall adjustments
have been made to the format, but a recent survey of checklist users reiterated that the basic
format continues to be useful and appropriate.
Referencing: we recommend using the Harvard style citation, i.e.: Critical Appraisal Skills
Programme (2018). CASP (insert name of checklist i.e. Systematic Review) Checklist. [online]
Available at: URL. Accessed: Date Accessed.
©CASP this work is licensed under the Creative Commons Attribution – Non-CommercialShare A like. To view a copy of this license, visit
Critical Appraisal Skills Programme (CASP) part of Oxford Centre for Triple Value Healthcare Ltd
Section A: Are the results of the review valid?
1. Did the review address a
clearly focused question?
Yes HINT: An issue can be ‘focused’ In terms of
• the population studied
• the intervention given
• the outcome considered
Can’t Tell
2. Did the authors look for the
right type of papers?
Yes HINT: ‘The best sort of studies’ would
• address the review’s question
• have an appropriate study design
(usually RCTs for papers evaluating
Can’t Tell
Is it worth continuing?
3. Do you think all the
important, relevant studies
were included?
Yes HINT: Look for
• which bibliographic databases were
• follow up from reference lists
• personal contact with experts
• unpublished as well as published studies
• non-English language studies
Can’t Tell
Paper for appraisal and reference:
4. Did the review’s authors do
enough to assess quality of
the included studies?
Yes HINT: The authors need to consider the
rigour of the studies they have identified.
Lack of rigour may affect the studies’
results (“All that glisters is not gold”
Merchant of Venice – Act II Scene 7)
Can’t Tell
5. If the results of the review
have been combined, was it
reasonable to do so?
Yes HINT: Consider whether
• results were similar from study to study
• results of all the included studies are
clearly displayed
• results of different studies are similar
• reasons for any variations in results are
Can’t Tell
Section B: What are the results?
6. What are the overall results of the review? HINT: Consider
• If you are clear about the review’s
‘bottom line’ results
• what these are (numerically if
• how were the results expressed (NNT,
odds ratio etc.)
7. How precise are the results? HINT: Look at the confidence intervals, if
Section C: Will the results help locally?
8. Can the results be applied to
the local population?
Yes HINT: Consider whether
• the patients covered by the review
could be sufficiently different to your
population to cause concern
• your local setting is likely to differ much
from that of the review
Can’t Tell
9.Were all important outcomes
Can’t Tell
HINT: Consider whether
• there is other information you would
like to have seen
10. Are the benefits worth the
harms and costs?
Yes HINT: Consider
• even if this is not addressed by the
Can’t Tell review, what do you think?

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