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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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