Objectives and hypotheses
Are the objectives of the study clearly stated?
Yes. The objectives were to address the unique aspects of children with real or potential cervical spinal injuries and provide recommendations regarding their management
Is the study design suitable for the objectives?
Yes, it is a review of all the relevant literature
Were the search methods used to locate relevant studies comprehensive?
Search was done in Medline (1966-2001) under the medical subject headings "child" AND "spinal cord injuries", which yielded 1022 citations, These citations were reviewed in combination with "cervical vertebrale", "spinal injuries" and "child". This yielded 152 citations, of which non-english citations were deleted and case reports were excluded. This left 58 articles, one of which was a class II study and the rest were class III. In addition, 6 articles germaine to the topic but not meeting the criteria for inclusion in evidentiary tables were included. Altogether, the search parameters did not produce a comprehensive list of all available articles
Was this the right sample to answer the objectives?
The articles used were appropriate, and relevant to the topic
Is the study large enough to achieve its objectives?
Although the study reviews only 64 papers, the literature on the subject is not very extensive, therefore, this review provides an overview of the best evidence available
Were all the studies accounted for?
Yes, all papers were included in tables and their findings were summarized, and also discussed in the text
Were all appropriate outcomes considered?
Yes, both bony fractures, spinal cord injuries with or without radiological abnormality were considered for recommendations for diagnostic and treatment guidelines
Has ethical approval been obtained if appropriate?
Measurement and observation
Is it clear what was measured, how it was measured and what the outcomes were?
Yes, the authors extensively reviewed all the papers found on a medline search and provided recommendations for both diagnostic and treatment guidelines
Were explicit methods used to determine which studies to include in the review?
Well the authors haven't been particularly clear about the methods they used to determine the studies that were included in the review, as there is no particular reference to any of the standardised methods
Was the selection of primary studies re-producible and free from bias?
We could not reproduce the search, as it was poorly described (we found 578939) following the articles strategy. There is also bias in the selection of papers, as all non-english language articles were excluded. Also there is no mentioning to contacting experts or review of 'grey' literature.
Was the methodologic quality of the primary studies assessed?
Yes, there is criticism of the methodology of several papers
Are the measurements valid?
Are the measurements reliable?
Are the measurements reproducible?
Presentation of results
Are the basic data adequately described?
Yes the basic data of each individual study is summarised in tables
Were the differences between studies adequately described?
Yes to a large extent
Are the results presented clearly, objectively and in sufficient detail to enable readers to make their own judgement?
The authors report the results of individual studies and present the best evidence enabling the readers to make their own judgement
Are the results internally consistent, i.e. do the numbers add up properly?
Were the results of primary studies combined appropriately?
Yes there was extensive analysis and comparison of the primary studies
Has a sensitivity analysis been performed?
Were all the important outcomes considered?
Are the data suitable for analysis?
Are the methods appropriate to the data?
Are any statistics correctly performed and interpreted?
Are the results discussed in relation to existing knowledge on the subject and study objectives?
Yes there is a very good discussion of all available evidence on the subject and it covers extensively all study objectives
Is the discussion biased?
No, as it is based on the available evidence
Are the author's conclusions justified by the data?
Yes all the conclusions are drawn from evidence and comparison of the primary studies
What level of evidence has this paper presented?
All primary studies were Class III apart from one which was Class II
Does this paper help me to answer my problem?
Yes this paper was the most recent and up-to-date article for the problem
Can any necessary change be implemented in practice?
Guidelines suggested are based on the best evidence available and can readily be implemented in clinical practice
What aids to implementation exist?
The current lack of guidelines would probably mean that these guidelines would be readily taken-up
What barriers to implementation exist?
Fear of missing a cervical spine injury, still insufficient evidence to support diagnostic standards