We suggest a three-step approach when using an article from the surgical literature to guide your patient care: (1) assess whether the study can provide valid results, (2) review the results, and (3) consider how the results might be applied to your patient.
Randomization, concealment, intention-to-treat analysis, similarity of patients for known prognostic factors, blinding of patients and outcome assessors, and completeness of follow-up are important guides to study validity.
The 95% confidence interval around the treatment effect is a measure of precision.
Consider whether all of the clinically important outcomes were reported and whether the likely benefits of treatment outweigh the potential harm and costs.
M. Bhandari, MD, MSc; G.H. Guyatt, MD, MSc; Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Center, Room 2C12, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada. Please address requests for reprints to G.H. Guyatt. E-mail address for M. Bhandari: firstname.lastname@example.org
M.F. Swiontkowski, MD; Department of Orthopaedic Surgery, University of Minnesota, Box 492, Delaware Street N.E., Minneapolis, MN 55455