Conduct a critical appraisal of a systematic review article.
Complete a critical appraisal using the article, Kleinpell, R.M., Ely, E.W., & Grabenkort, R. (2008). Nurse
practitioners and physician assistants in the intensive care unit: An evidence-based review. Critical Care
Medicine, 36(10), 2888-2897, and the Systematic Review Appraisal Sheet (attached). It is recommended you review
the checklist of components to be included in a systematic review article (also attached) to assist you with this
Text S1 – Checklist of items to include when reporting a systematic review or meta-analysis
Section/topic # Checklist item Reported on page #

1 Identify the report as a systematic review, meta-analysis, or both.
2 Provide a structured summary including, as applicable: background; objectives; data sources; study
eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results;
limitations; conclusions and implications of key findings; systematic review registration number.


3 Describe the rationale for the review in the context of what is already known.
4 Provide an explicit statement of questions being addressed with reference to participants,
interventions, comparisons, outcomes, and study design (PICOS).

5 Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if
available, provide registration information including registration number.
6 Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g.,
years considered, language, publication status) used as criteria for eligibility, giving rationale.
7 Describe all information sources (e.g., databases with dates of coverage, contact with study
authors to identify additional studies) in the search and date last searched.
8 Present full electronic search strategy for at least one database, including any limits used, such
that it could be repeated.
9 State the process for selecting studies (i.e., screening, eligibility, included in systematic
review, and, if applicable, included in the meta-analysis).
10 Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate)
and any processes for obtaining and confirming data from investigators.
11 List and define all variables for which data were sought (e.g., PICOS, funding sources) and any
assumptions and simplifications made.
12 Describe methods used for assessing risk of bias of individual studies (including specification of
whether this was done at the study or outcome level), and how this information is to be used in any data
13 State the principal summary measures (e.g., risk ratio, difference in means).
14 Describe the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2) for each meta-analysis.
15 Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication
bias, selective reporting within studies).
16 Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression),
if done, indicating which were pre-specified.

17 Give numbers of studies screened, assessed for eligibility, and included in the review, with
reasons for exclusions at each stage, ideally with a flow diagram.
Study characteristics 18 For each study, present characteristics for which data were extracted (e.g., study
size, PICOS, follow-up period) and provide the citations.
Risk of bias within studies 19 Present data on risk of bias of each study and, if available, any
outcome-level assessment (see Item 12).
Results of individual studies 20 For all outcomes considered (benefits or harms), present, for each study:
(a) simple summary data for each intervention group and (b) effect estimates and confidence intervals, ideally
with a forest plot.
Synthesis of results 21 Present results of each meta-analysis done, including confidence intervals and
measures of consistency.
Risk of bias across studies 22 Present results of any assessment of risk of bias across studies (see
Item 15).
Additional analysis 23 Give results of additional analyses, if done (e.g., sensitivity or subgroup
analyses, meta-regression) (see Item 16).
Summary of evidence 24 Summarize the main findings including the strength of evidence for each main
outcome; consider their relevance to key groups (e.g., health care providers, users, and policy makers).
Limitations 25 Discuss limitations at study and outcome level (e.g., risk of bias), and at review level
(e.g., incomplete retrieval of identified research, reporting bias).
Conclusions 26 Provide a general interpretation of the results in the context of other evidence, and
implications for future research.
Funding 27 Describe sources of funding for the systematic review and other support (e.g., supply of
data); role of funders for the systematic review.