Best Evidence Topics

Review or meta-analysis

Marshall T
A review of tonsillectomy for recurrent throat infection
British Journal of General practice
June 1998, 48 1331-1335
  • Submitted by:Helen Slee - Medical student
  • Institution:Manchester University
  • Date submitted:16th July 2005
Before CA, i rated this paper: 5/10
1 Objectives and hypotheses
1.1 Are the objectives of the study clearly stated?
2 Design
2.1 Is the study design suitable for the objectives?
  Yes literature was searched for RCT's comparing tonsillectomy with non-surgical treatment for recurrent throat infection.
2.2 Were the search methods used to locate relevant studies comprehensive?
  yes medline and cochrane were searched, the medline search strategies were given.
2.3 Was this the right sample to answer the objectives?
  yes 5 studies were found which met the inclusion criteria:participants had suffered from recurrent throat infections, the experimental intervention was tonsillectomy or adenotonsillectomy and the study was randomised with control groups. 4 of these were published, 1 was published only as an abstract but the data was made available to the author
2.4 Is the study large enough to achieve its objectives?
  Only 5 studies were found together the studies included less than 350 patients.
2.5 Were all the studies accounted for?
2.6 Were all appropriate outcomes considered?
  No, the occurrence of side effects and the risks associated with the operation are not accounted for.
2.7 Has ethical approval been obtained if appropriate?
  Not required.
3 Measurement and observation
3.1 Is it clear what was measured, how it was measured and what the outcomes were?
  Yes, the annual incidence and annual reduction of all throat infections and of moderate and severe throat infections in tonsillectomy patients and controls.
3.2 Were explicit methods used to determine which studies to include in the review?
  Yes, searches were carried out, there was an inclusion criteria and trials were appraised.
3.3 Was the selection of primary studies re-producible and free from bias?
  Yes because of the inclusion criteria.
3.4 Was the methodologic quality of the primary studies assessed?
  Yes, the numbers, entry criteria, frequency of follow up and outcome assessment of each trial included was recorded.
3.5 Are the measurements valid?
3.6 Are the measurements reliable?
  For 2 of the studies the review author states that detailed case definitions of mild, moderate and severe throat infections were given but the other studies did not define their outcome measures. Only 2 of the studies tested inter-observer reliability.
3.7 Are the measurements reproducible?
  Not for the undefined studies.
4 Presentation of results
4.1 Are the basic data adequately described?
4.2 Were the differences between studies adequately described?
4.3 Are the results presented clearly, objectively and in sufficient detail to enable readers to make their own judgement?
4.4 Are the results internally consistent, i.e. do the numbers add up properly?
  Incidence figures so i cant tell.
5 Analysis
5.1 Were the results of primary studies combined appropriately?
  Not combined
5.2 Has a sensitivity analysis been performed?
5.3 Were all the important outcomes considered?
  Outcomes apart from reduction in throat infection are only briefly discussed .
school absence figures are given for only 2 of the studies but these excluded the time off required at the time of the operation. complication of the operation are not discussed.
5.4 Are the data suitable for analysis?
  The data was not analysed together however some analysis reported from the trials is included
5.5 Are the methods appropriate to the data?
  Yes, one of the trials gave p values for the difference in incidence of throat infection.
5.6 Are any statistics correctly performed and interpreted?
6 Discussion
6.1 Are the results discussed in relation to existing knowledge on the subject and study objectives?
6.2 Is the discussion biased?
7 Interpretation
7.1 Are the author's conclusions justified by the data?
7.2 What level of evidence has this paper presented?
7.3 Does this paper help me to answer my problem?
  this review is helpful as it appears to have found the best available evidence, however because the evidence is insufficient it is only moderately helpful.
After CA, i rated this paper: 5/10
8 Implementation
8.1 Can any necessary change be implemented in practice?
  no change is advised
8.2 What aids to implementation exist?
8.3 What barriers to implementation exist?