GATE: a Graphic Approach To Evidence based practice

Critically Appraised Topic (CAT): Applying the 5 steps of Evidence Based Practice
Using evidence from iagnostic test acc!racy st!dies
Assessed "y: ate:
Pro"lem
#tep $: As% a foc!sed 5&part '!estion !sing PEC(T frame)or%
Population /
patient / client
Exposure
(Target disorder)
Comparison(no
Target disorder)
Outcome (Test)
Time
#tep *: Access (#earch) for the "est evidence !sing the PEC(T frame)or%
PECOT item Primary Search Term Synonym Synonym !
Pop!lation +
Participants /
patients / clients
O" O" #$%
Exposure
(Target disorder)
O" O" #$%
Comparison (no
Target disorder)
O" O" #$%
(utcomes (Test) O" O" #$%
(Time) #$% #$%
,imits -.ilters
ata"ases searched:
%atabase Cochrane S"s Other Secondary
Sources
Pub&ed /
Ovid&edline
Other
$umber o'
publications
((its)
Evidence Selected
)usti'ication 'or selection
iagnostic test acc!racy st!dies
#tep /: Appraise #t!dy
/a0 escri"e st!dy "y hanging it on the GATE frame (also enter st!dy n!m"ers into the separate e1cel
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GATE CAT 2 iagnostic Test Acc!racy

#t!dies
GATE calc!lator)
P
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Setting
P
Eligible Population
Study
Setting
Eligible
population
"ecruitment
process
Participants
E
1
p
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!
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e

-

C
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p
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E1pos!re Gro!p Comparison
Gro!p
(EG) (CG)
EG CG
3# 4ve 3# &ve
#llocation
method
Exposure
("e' Std-
2ve)
Comparison
("e' Std- 3
ve)
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rt-.ac/son0auc/land-ac-n1
!
(
!
t
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s
O
.5
TP
.5 T5
Outcome(s)
(Test)
T
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Time
3
e
p
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t
e
d

3
e
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!
l
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s
Enterthe main reported res!lts
Outcome
"is/
estimate
Con'idence 4nterval
Sensitivity
Speci'icity
Complete the 5!m"ers on the separate GATE Calc!lator for iagnostic#t!dies
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rt-.ac/son0auc/land-ac-n1
+
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rt-.ac/son0auc/land-ac-n1
5
iagnostic test acc!racy st!dies
#tep /: Appraise #t!dy
/"0 Assess ris% of errors !sing 3A6"o6A5
Appraisal'!estions (3A6"o6A5)
3is%
oferrors
47 17 87
na
$otes
"ecruitment/#pplicability6errors9: 7uestions on ris/s to application o' results in practiceare in blue boxes
4nternal study design errors: 7uestions on ris/ o' errors 8ithin study (design 9 conduct) are in pin/ boxes
#nalyses errors: 7uestions on errors in analyses are in orange boxes
"andom error: 7uestions on ris/ o' errors due to chance are in the green box
:ey for scoring ris% of errors: 4 ; lo)< 1 ; of concern< 8 ; !nclear< na ; not applica"le
P
a
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t
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i
p
a
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t

P
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a
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i
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3ecr!itment appropriate to study ob.ectives:4s it possible to de'ine groups/populations that the 'indings
are applicable to:
Study Setting appropriate: Score ris/
o' error as:
2; x; : or
na (see /ey
above)
Study planned be'ore re'erence
standard and tests done:
Eligible population appropriate:
Participants similar to all eligibles:
<ey personal (ris//prognostic)
characteristics o' participants
reported: #ppropriate spectrum o'
participants:
E
1
p
o
s
!
r
e
s

-
C
o
m
p
a
r
i
s
o
n
s
Allocationto E= 9 C= done 8ell:
"e'erence standard su''iciently 8ell
de'ined and 8ell measured so
participants allocated to correct Target
disorder groups:
"e'erence standard measured prior to
Test: 4' not; 8as it measured blind to
Test result:
Prevalence (pre>test probability) o'
Target disorder typical o' usual
practice:
6aintenance in allocated groupsand throughout study su''icient:
Proportion o' intended participants
receiving both Test and "e'erence
Standardsu''iciently high:
Change in Target disorder/Test status
in period bet8een Test and "e'erence
Standard being administered
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?
iagnostic test acc!racy st!dies
#tep =: Apply0 Consider+)eigh !p all factors - ma%e (shared) decision to act
Epidemiological Evidence
#ystem feat!res
>al!es - preferences
Case Circ!mstances
Economic
,egal
Political
Patient - .amily
Practitioner
Comm!nity
ecision
Epidemiological evidence: summarise the 7uality o'
the study appraised; the magnitude and precision o'
the measure(s) estimated and the applicability o' the
evidence- #lsosummariseits consistency 8ith other
studies (ideally systematic revie8s) relevant to the
decision-
Case circumstances: 8hat circumstances(e-g- disease
process/ co>morbidities @mechanistic evidenceA; social
situation) speci'ically related to the problem you are
investigating may impact on the decision:
System 'eatures: 8ere there any system constraint or
enablers that may impact on the decision:
Bhat values 9 pre'erences may need to be
considered in ma/ingthedecision:
ecision: Ta/ing into account all the 'actors above 8hat is the best decision in this case:
#tep 5: A!dit !s!al practice (.or ?!ality @mprovement)
4s there li/ely to be a gap bet8een your usual practice and best practice 'or the problem:
The A&factor