Levels of Evidence

Shikher Shrestha

NINAS

Evidence Based Medicine

Integration of

Current best research evidence

Clinical Expertise

Patient’s values, preferences and

circumstances

Components

Randomized Controlled Study..

Searching for the Best Evidence

Systematic Review

Systematic Review and Meta-analysis

Statistical technique to integrate result: metaanalysis

Why do we need it?

25000 biomedical journals in print

8000 articles published per day

All studies not equally designed

Need summary of evidence that addresses a specific clincal

question

Limit bias

Cochrane Systematic Review

Clinical Practice Guidelines..

Consensus based vs Evidence Based

Does not need to reinvent the wheel

Few Landmark Papers and their LOE:

International Cooperative Study on Timing of Aneurysm Surgery; Kassell

et al: 2 Radiological Predictors of Vasospasm, Fisher; Frontera: 3

ISAT; Coiling Vs Clipping:; Molyneux et al;: 1

Nimodipine trial; Pickard et.al; : 1

STICH Trial; Mendelow etal; : 1

Destiny, Decimal, Hamlet;: 1

CEA vs Carotid stenting; Eckstein et al ;: 1

Steroids for mx of cerebral edema in brain tumors; Vecht et

al;: 1

Surgery+ Radx vs Sx in single brain mets; Mintz; Patchell;

vecht: 1

Extent of Glioma resection; Keles 2; Lacroix 2; Vuorinen 1;

Stummer 2

Early concomitant systemic chemotherapy with radiotherapy

for GBM; Stupp 1

In a nutshell…

Thank you!!!