CRITICAL APPRAISAL TEMPLATE: PROSPECTIVE COHORT STUDY
(Observational)
Clinical Question
*Intervention could be a treatment, exposure, or presence of a factor
**If applicable, compared to those without the treatment, exposure, or factor
***Likelihood of adverse outcome attributable to the intervention
Citation
Guide
I Are the results valid?
1 Was the cohort
representative of the
population? Was everyone
included who should have
been?
2 Were the methods for
determining exposure
objective and consistent
across the cohort? Were
the tools validated, where
applicable?
3 Were the methods for
determining outcome
objective and consistent
across the cohort? Were
the tools validated, where
applicable?
4 Were the subjects and/or
the outcome assessor
blinded to exposure?
P – all pediatric patients diagnosed with sepsis
based on the SIRS criteria
I* - The data were taken from laboratory and
physical examinations by the physicians on duty
C** - To compare the accuracy of three
mortality predictor tools: severe sepsis criteria,
pediatric logistic organ dysfunction (PELOD)-2,
and pediatric sequential organ failure
assessment (pSOFA), in critically ill children with
sepsis.
O*** - better predictor of mortality
Comments
1. Yes.
2. No, because the research exclude patients with previously
known malignancy, hematological abnormalities, or
congenital heart, lung, or kidney anomalies were excluded
from the study
1. Yes, because the study started in September 2018 ended in
March 2019 and employed a consecutive sampling method
2. Yes, the tools used in this study like SIRS, PELOD, and
pSOFA were validated and applicable.
1. Yes, The prognostic accuracy of the three methods of
assessment for sepsis (severe sepsis criteria, PELOD-2, and
pSOFA ) can be compared with various diagnostic parameters the
methods for determining outcome (mortality predictor).
2. Yes, the tools were validated. Because the study use 95%CI and
p<0,05
No. Because the study use exclusion criteria to choose the subjects
like previously known malignancy, hematological abnormalities, or
congenital heart, lung, or kidney anomalies.
 5 Have all important No. The study doesn’t limit age as confounding factor for the subject
confounding factors been criteria. In the discussion, mentioned that younger age has been
identified and accounted for associated with immune system immaturity and is usually accompanied
in the design and/or by comorbidities.
analysis?
6 Was follow-up of subjects Yes, because there are no subject drop out from the study.
complete? and sufficiently Yes, because the study start within 6 months and the mean of length
long? of stay (LOS) was 8,7 days.

II What were the results?

1 How strong is the
association between
exposure and outcome
(relative risk)? What is the
absolute risk reduction (risk
difference)?
From three methods, only pSOFA has strong asosiation with
outcome (P=0.039).
However severe sepsis criteria, and PELOD-2 were not significant
predictors for mortality (P> 0.05).

2 How precise is the estimate The OR value for the pSOFA was also the highest at 10.111 (95%CI
of risk (confidence 1.054 to 97.002).
intervals)?

III How can I apply the results to my patient care?

1 Were the study patients Yes, because of the study used 95%CI and represents the population.
similar to my patient?

2 Is the exposure similar to Yes, but until now we haven’t found the case
what might occur in my
patient?

3 Are there benefits that Yes, we can apply in my patient because we can predict mortality for
offset the risks of the low budget
exposure?
Summary & Conclusions

This study is Valid, Importance and, Applicable