Critical appraisal:Verbeek RE, van Oijen MG, ten Kate FJ, Vleggaar FP, Schipper ME, Casparie MK, et al 2012 4

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Critical Appraisal

Article being appraised

Verbeek RE, van Oijen MG, ten Kate FJ, Vleggaar FP, Schipper ME, Casparie MK, et al. Surveillance and follow-up strategies in patients with high-grade dysplasia in Barrett's esophagus: a Dutch population-based study. Am J Gastroenterol 2012 Apr 1;107(4):534-42 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22270082.


Applicable clinical question

Key Facts

Study Design

cohort study, risk factors

Number of Patients:

827


Includes an economic evaluation

no

Evidence ratings

Level of evidence

II

Risk of bias
Moderate risk of bias Comments: Population-based cohort of patients with BE+HGD established in the Netherlands. Of 827 patients meeting entry criteria, follow-up achieved on 699. Exposure variables limited in number, and abstracted solely from pathology reports.

Risk of bias assessment: cohort study (risk factors)

Bias in selection of participants into study
Selection of the exposed and non-exposed cohorts
Drawn from the same population (low risk)
Bias due to error in exposure measurement
Measurement of exposure
Objective measurements from pre-existing records or <img alt="File:Jutta's info icon.png" src="/australiawiki_test/images/d/d9/Jutta%27s_info_icon.png" width="16" height="16"> baseline (Existing at or before baseline, where baseline is the time at which a participant is recorded to have entered the cohort or, if obtained after baseline, before onset of symptoms of the outcome or any likely effect of the developing outcome on the exposure) physical or biological assessment blind to outcome status (low risk)
Bias due to error in outcome measurement
Measurement of outcome
Outcome measurement unlikely to be influenced by exposure (low risk)
Was outcome of interest absent at the time to which the exposure refers?
Yes (low risk)
Was follow-up long enough for outcome to occur as a consequence of measured exposure? (Requires prior specification of a sufficient follow-up period)
Yes (low risk)
Bias due to non-participation
Participation rate in cohort
Participation rate in exposed cohort ≤10 percentage points different from non-exposed cohort OR exposed and non-exposed are from the same cohort (low risk)
Bias due to missing data
Completeness of follow-up of cohort
Active or passive follow-up with methods for ascertainment of outcome, death and emigration from population-at-risk not clearly described OR there is a plausible estimate of 70 – 90% follow-up (moderate risk)
Accuracy of dates of outcome or censoring
Dates of outcome or censoring ascertained to within one year (low risk)
Difference in follow-up between exposed and non-exposed members of cohort
No response
Difference in missing data for exposure between those with or without the outcome
Difference in missing data for exposure < 10 percentage points (low risk)
Bias due to confounding
Comparability of exposed and non-exposed cohorts with respect to potentially important confounding variables (Requires prior specification of potentially important confounders)
No potentially important confounders or only age controlled by design or in analysis OR insufficient information to tell (high risk)
Analysis bias
Covariates are appropriately included in statistical analysis models
Variables measuring the same underlying concept or lying in the same causal pathway ARE included together as covariates in statistical analysis models OR insufficient information to tell (high risk)
Size of effect
1 Reason for decision: RATE OF EAC IN HGD PATIENTS

1 yr 0.30 (0.29-0.34)
3 yrs 0.35 (0.33-0.39)
5 yrs 0.41 (0.38-0.45)
Increased risks of progression with older age and lower risks with unifocal HGD.

Relevance of evidence
1 Additional comments: This prospective cohort study constitutes level II evidence. The study incorporates clinically relevant outcomes.
Result of appraisal

Jutta's tick icon.png Included




Completed by

David Whiteman



Jutta's tick icon.png This appraisal has been completed.


Article
Verbeek RE, van Oijen MG, ten Kate FJ, Vleggaar FP, Schipper ME, Casparie MK, et al. Surveillance and follow-up strategies in patients with high-grade dysplasia in Barrett's esophagus: a Dutch population-based study. Am J Gastroenterol 2012 Apr 1;107(4):534-42 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22270082.
Assigned to
User:Philip.craig
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


Section below only relevant for Cancer Council Project Officer

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