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Updated: Jun 18 2021

Level of Evidence

  • Introduction
    • A method utilized in the 3rd step of evidence based medicine (EBM) to determine the clinical value of a study
      • five steps of EBM
        • formulate an answerable question
        • gather the evidence
        • appraise the evidence
        • implement the evidence
        • evaluate the process
    • See details of Clinical Design Trials
  • Different Levels of Evidence
      • Different Levels of Evidence
      • 1. Randomized controlled trial (RCT)
      • a study in which patients are randomly assigned to the treatment or control group and are followed prospectively
      • 2. Meta-analysis of randomized trials with homogeneous results
      • 1.  Poorly designed RCT
      • Follow up less than 80%
      • 2. Prospective cohort study (therapeutic)
      • A study in which patient groups are separated non-randomly by exposure or treatment, with exposure occurring after the initiation of the study
      • 3.  Meta-analysis of Level 2 studies
      • 1. Retrospective cohort study
      • A study in which patient groups are separated non-randomly by exposure or treatment, with exposure occurring before the initiation of the study
      • 2. Case-control study
      • A study in which patient groups are separated by the current presence or absence of disease and examined for the prior exposure of interest
      • 3. Meta-analysis of Level 3 studies
      • Level 4
      • 1. Case series
      • A report of multiple patients with the same treatment, but no control group or comparison group
      • 1. Case report (a report of a single case)
      • 2. Expert opinion
      • 3. Personal observation
  •  JBJS Level of evidence
      • AAOS Evidence-Based Practice Committee Recommendations in Clinical Practice Guidelines
      • Strong
      • Two or more HIGH quality studies
      • Moderate
      • One HIGH or 2 MODERATE quality studies
      • Weak
      • One MODERATE or 1 or more LOW quality studies
      • Consensus
      • Expert opinion (no studies)
      • *Only used in one circumstance: It pertains to medical interventions that potentially prevent loss of life or limb (catastrophic consequences).
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Question
1 of 13
In scope icon N/A
QID 218161 (Type "218161" in App Search)
A 24-year-old baker presents to the clinic after slipping on a bag of spilled flour and falling onto an outstretched right hand. She is right-hand dominant and has not been able to whisk or lift pans out of the oven without significant pain in the wrist and thenar eminence since the time of the fall 7 days ago. Radiographs taken in the clinic today are shown in Figure A. Which of the following provides the most compelling reason to pursue open reduction internal fixation (ORIF) of her fracture at this time?
  • A

Fracture chronicity

2%

11/676

Fracture location

88%

598/676

Involvement of dominant extremity

2%

11/676

Patient age

3%

17/676

Patient occupation

5%

33/676

  • A

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Basic Science⎪Level of Evidence
  • Basic Science
  • - Level of Evidence
18:37 min
7/21/2020
374 plays
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