Updated: 12/29/2021

Level of Evidence

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  • Introduction
    • Evidence-based medicine (EBM) involves using data derived from the scientific method to improve clinical decision-making
    • In applying evidence to treat patients, physicians must understand which types of evidence to prioritize
      • some evidence is more reliable than others based on study design and quality
  • Levels of Evidence
    • Level 1 (highest)
      • 1a
        • systemic review and/or meta-analysis of high-quality randomized control trials (RCTs)
          • systemic reviews synthesize previous studies to increase precision and generalizability
          • meta-analysis is the statistical procedure for combining numerical results from synthesized studies
      • 1b
        • single high-quality RCT
          • studies in which patients are randomly assigned to the treatment or control group and are followed prospectively
    • Level 2
      • 2a
        • high quality non-randomized control trials
      • 2b
        • high quality cohort studies
          • prospective cohort
            • studies in which patients are assigned to groups in a non-random fashion by exposure (e.g., treatment or risk factor) with the outcome occurring after the initiation of the study
          • retrospective cohort
            • a study in which patients are assigned to groups in a non-random fashion by exposure (e.g., treatment or risk factor) with the outcome occurring before the initiation of the study
    • Level 3
      • case-control studies
        • studies in which patients are assigned to groups in a non-random fashion by their outcome status (e.g., diseased or not-diseased) and examined for the prior exposure of interest
    • Level 4
      • cross-sectional studies
        • study in which exposure and outcome are assessed simultaneously
      • case series
        • a report of multiple patients with the same disease or treatment but no control group or comparison group
    • Level 5
      • case report
        • detailed description of a single patient's symptoms, signs, treatment, and disease course
        • expert opinion
        • editorials

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