New evidence pyramid

M Hassan Murad, Noor Asi, Mouaz Alsawas, Fares Alahdab, M Hassan Murad, Noor Asi, Mouaz Alsawas, Fares Alahdab

Abstract

A pyramid has expressed the idea of hierarchy of medical evidence for so long, that not all evidence is the same. Systematic reviews and meta-analyses have been placed at the top of this pyramid for several good reasons. However, there are several counterarguments to this placement. We suggest another way of looking at the evidence-based medicine pyramid and explain how systematic reviews and meta-analyses are tools for consuming evidence—that is, appraising, synthesising and applying evidence.

Keywords: EDUCATION & TRAINING (see Medical Education & Training); EPIDEMIOLOGY; GENERAL MEDICINE (see Internal Medicine).

Figures

Figure 1
Figure 1
The proposed new evidence-based medicine pyramid. (A) The traditional pyramid. (B) Revising the pyramid: (1) lines separating the study designs become wavy (Grading of Recommendations Assessment, Development and Evaluation), (2) systematic reviews are ‘chopped off’ the pyramid. (C) The revised pyramid: systematic reviews are a lens through which evidence is viewed (applied).

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Source: PubMed

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