Best Evidence Topic (BET) Format

Full details of the structure and creation process for a BET review are given here.

BETs are similar to the Critically Appraise Topic (CAT) devised by Sackett et al. They are modified for use in Emergency Medicine, where many of the questions raised by the varied clinical workload are not addressed by high quality clinical trials. BETs allow the inclusion of lower quality evidence, by listing weaknesses of papers included for evaluation. The same rigorous approach to finding papers is taken. It should be noted, however, that BETs are not systematic reviews of the sort conducted by the Cochrane Collaboration, and therefore include only published evidence.

In a busy specialty, with a wide variety of clinical problems, some minor and not covered by widely publicised guidelines, BETs allow clinicians rapid access to the best available evidence, summarised in a patient-centred way.

The 3 part question

Central to the creation of a BET review is the posing and refinement of the question to be asked. It should be concise, precise and able to be answered from the literature. The format is shown below.

General Question
Clinical problem
Is a haematoma block the best way to reduce a Colles fracture
3 part question
Patient characteristic
In [elderly patients with a Colles fracture]
Intervention(s) or Defining Question
Is [a haematoma block better than a Biers block]
Relevant Outcome(s)
At [reducing pain during manipulation and decreasing the need for remanipulation]

The BET report format

Once the literature has been comprehensively searched, and relevant papers found, the best evidence is summarised in a standard format. Together with details of the review's author and the date of creation, this forms the final report (shown below).

Best Evidence Topic Report
Report by
Search checked by
Clinical scenario
Three part question
Search strategy
Search outcome
x papers found of which y irrelevant and z of insufficient quality for inclusion
Relevant papers

Author, date and country
Patient group
Study type (level of evidence)
Key results
Study weaknesses

Clinical bottom line

BETs in use

BETs can be used by clinicians at the point of patient contact. They can be relied upon as being an unbiased, up-to-date summary of the best evidence for treatment or diagnostic choices. They are quick to search and read. BETs offer several clear advantages, therefore, over textbooks held in departmental libraries, or ad hoc personal knowledge, half-remembered from a journal read several months ago.

In the Accident & Emergency Department of Manchester University, where BETs were devised, the review of BETs written by staff regularly informs and changes departmental policies, as well as indicating avenues for research.

What constitutes best evidence is constantly changing, and BETs are therefore reviewed at regular intervals - generally between 6 and 12 months, using the same standard search strategies as used in the original compilation of the review.