CASP Checklist: 11 questions to help you make sense of a Case Control Study

How to use this appraisal tool: Three broad issues need to be considered
when appraising a case control study:

Are the results of the study valid?

(Section A) What are the results?
(Section
B) Will the results help locally?
(Section
C)

The 11 questions on the following pages are designed to help you think
about these issues systematically. The first three questions are screening
questions and can be answered
quickly. If the answer to both is “yes”, it is worth proceeding with the
remaining questions. There is some degree of overlap between the
questions, you are asked to record a “yes”, “no” or “can’t tell” to most of
the questions. A number of italicised prompts are given after
each question. These are designed to remind you why the question is
important. Record your reasons for your answers in the spaces provided.

About: These checklists were designed to be used as educational pedagogic

tools, as part of a workshop setting, therefore we do not suggest a scoring
system. The core CASP checklists (randomised controlled trial & systematic
review) were based on JAMA 'Users’ guides to the medical literature 1994
(adapted from Guyatt GH, Sackett DL, and Cook DJ), and piloted with health
care practitioners.
For each new checklist, a group of experts were assembled to develop and
pilot the checklist and the workshop format with which it would be used.
Over the years overall adjustments have been made to the format, but a
recent survey of checklist users reiterated that the basic format continues
to be useful and appropriate.
Referencing: we recommend using the Harvard style citation, i.e.: Critical
Appraisal Skills Programme (2018). CASP (insert name of checklist i.e.
Case Control Study) Checklist. [online] Available at: URL. Accessed: Date
Accessed.

©CASP this work is licensed under the Creative Commons Attribution –

Non-Commercial- Share A like. To view a copy of this license, visit
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Critical Appraisal Skills Programme (CASP) part of Oxford Centre for Triple Value Healthcare Ltd www.casp-uk.net
Paper for appraisal and reference: Gambaran Karies Gigi Sulung pada Anak Stunting di Indonesia
Section A: Are the results of the trial valid?

1. Did the study Yes HINT: An issue can be ‘focused’ In

address a clearly  terms of
focused issue? Can’t • the population studied
Tell  Whether the study tried to detect
a
No beneficial or harmful effect
• the risk factors studied

Comments:

2. Did the authors Yes

use an HINT: Consider
appropriate Can’t
method to answer  Is a case control study an
Tell appropriate way of answering the
their question?
question under
No the

circumstances Did it
address the study
question

Comments:

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 Is it worth continuing?

3. Were the cases Ye HINT: We are looking for

recruited in an s  selection bias which might
acceptable way? compromise validity of the
Can’t findings
Tell • are the cases defined precisely
• were the cases
No representative of a defined
population (geographically
and/or temporally)
Comments:  was there an established
reliable system for
selecting all the cases
 are they incident or prevalent
 is there something special about
the
cases
 is the time frame of the
study relevant to
disease/exposure
 was there a sufficient number of
cases selected
 was there a power calculation

4.Were the controls Ye HINT: We are looking for

selected in an s selection bias which
acceptable way?  might compromise the
Can’t generalisability of the
Tell findings
• were the controls
No representative of the defined
population (geographically
and/or temporally)
 was there something special
Comments: about
the controls
 was the non-response
high, could non-
respondents be different
in
any way
 are they matched,
population based or
randomly selected

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 was there a sufficient
number of
controls selected

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5.Was the exposure Ye HINT: We are looking for
accurately measured to s  measurement,
minimise bias? recall or classification bias
Can’t • was the exposure clearly defined
Tell and
accurately measured
No  did the authors use
subjective or
objective
Comments: measurements
 do the measures truly
reflect what they are
supposed to measure (have
they been validated)
 were the measurement
methods similar in the
cases and controls
 did the study incorporate
blinding
where feasible
 is the temporal relation
correct (does the
exposure of interest
precede the outcome)

6.(a) Aside from the Yes

experimental HINT: List the ones you think
intervention, were Can’
might be important, that the
the groups treated t
 author may have
equally? Tell missed
• genetic
No
 environmental
 socio-economic

List:

6. (b) Have the authors Ye o

taken account of the s
potential confounding
factors in the design
Can’t
and/or in their
Tell
analysis?
N

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 HINT: Look for modellin d-, regression-, or sensitivity
• restriction in design, g, analysis to correct, control or
and techniques e.g. stratifie adjust for confounding factors

Comments:

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Section B: What are the results?

7. How large was the treatment effect? HINT: Consider

 what are the bottom line
results
 is the analysis appropriate to
the design
Comments:  how strong is the association
Memiliki efek karena bahasan dalam between exposure and
jurnal memiliki makna dan sejajar dengan
hasil akhir.
outcome (look at the odds
ratio)
 are the results adjusted for
confounding, and might
confounding still explain the
association
 has adjustment made a big
difference to the OR

8. How precise was the estimate of the HINT: Consider

treatment
effect?  size of the p-value
 size of the confidence intervals
 have the authors considered all
the
important variables
 how was the effect of subjects
refusing to participate evaluated

Comments: Cukup tepat

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 9.Do you believe the results?
HINT:
Consider
 big effect is hard to ignore!
 Can it be due to chance,
confounding
bias,
 are the design andor
Y
methods of this study
sufficiently flawed to make
es the
results unreliable
N  consider Bradford Hills criteria
(e.g. time sequence, does-
response gradient,
o strength, biological
plausibility)
Comments:

Section C: Will the results help

locally?

10. Can the results be applied Yes  HINT: Consider whether

to the local population?  the subjects covered in the study
could
Can’t be sufficiently different from your
Tell population to cause concern
No  your local setting is likely
to differ much from
that of the study
 can you quantify the local
benefits and
harms
Comments:

11. Do the results of this study Yes  HINT:

fit with other available Consider
 all the available evidence
from RCT’s
evidence? Can’t Systematic Reviews, Cohort
Tell Studies,
and Case Control Studies as

Remember One observational study rarely provides sufficiently robust evidence to

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recommend changes to clinical practice or within health policy decision making.
However, for certain questions observational studies provide the only evidence.
Recommendations from observational studies are always stronger when supported
by other evidence.

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