“Critical appraisal is the course of action for watchfully and systematically

examining research to assess its reliability, value and relevance in order to

direct professionals in their vital clinical decision making.”

Al-Jundi A, Sakka S. Critical Appraisal of Clinical Research. J Clin Diagn Res. 2017;11(5):JE01-JE05.

doi:10.7860/JCDR/2017/26047.9942

Definition
Alfian Nurfaizi
19 September 2021
TOOLS
CRITICAL APPRAISAL
STUDY validity

● The population studied is to all symptomatic and asymptomatic staff working at four teaching hospitals in
Oxfordshire, United Kingdom
● The risk factors in this study is all symptomatic staff (those with new persistent cough, temperature ≥37.8°C,
or anosmia or ageusia) and voluntary asymptomatic health care workers.
● The study tried to detect benefit or harmful effect and outcome of seropositive and seronegative for SARS-
CoV-2 antibodies clearly.
● The cohort define the representation of the population with thousands of samples included.
● Something special about the cohort is only voluntary asymptomatic health care workers include for
represent the asymptomatic population.
● The study using total sampling to included all who should have been.
● In this study using the objective measurements by tools which has accurate measurements.
● Validation of measurements tools in this study is anti-trimeric spike IgG enzyme-linked immunosorbent
assay (ELISA) developed by the University of Oxford and anti-nucleocapsid IgG assay developed by Abbott.
● All subjects classified into exposure groups using the same procedure by combine nasal and
oropharyngeal swab specimens.
● In this study using the objective measurements that have been validated
● The similar methods measurement conduct in the different group
● But there are no information about blinded of this study.
● The authors have identified all important confounding factors like age, gender, race or ethnic group, roles,
and the symptoms.
● The confounding factors have analyzed by Poisson regression.
● There are no lost to
follow-up persons in
this study so that the
study outcome is not
affected.

● The study followed up

in six months,
sufficient time to
assess the outcome
accurately
STUDY RESULTS

● A total of 12,541 health care workers participated and had anti-spike IgG measured; 11,364 were followed up after negative antibody
results and 1265 after positive results, including 88 in whom seroconversion occurred during follow-up.
● A total of 223 anti-spike–seronegative health care workers had a positive PCR test (1.09 per 10,000 days at risk), 100 during screening
while they were asymptomatic and 123 while symptomatic, whereas 2 anti-spike–seropositive health care workers had a positive PCR
test (0.13 per 10,000 days at risk).
● There were no confirmed symptomatic infections in seropositive health care workers.
● Adjusted incidence rate ratio (based on IgG Anti-Spike Antibody Status ) , 0.11; 95% confidence interval, 0.03 to 0.44; P=0.002.
● Rate ratios were similar when the anti-nucleocapsid IgG assay was used alone or in combination with the anti-spike IgG assay
● Adjusted incidence rate ratio (based on IgG Anti-Spike Antibody Status ) , 0.11; 95% confidence interval,
0.03 to 0.44; P=0.002.
● There a no big effect affecting study bias, confounding variable well analyzed through Poisson regression
● Study design and methods are well explained in complete and accurate
● This study explain the time sequence, tools, methods, and writing consistency in coherent and complete
STUDY IMPACT

● The subject covered in this study could be sufficiently different from our population (Indonesia) due to
differences in race, environmental, and variants of SARS CoV-2.
● But this study can be used as initial consideration to predicting the outcome locally before the local studies
are held according to this procedure.
● Incidence of SARS-CoV-2 infectioninhealth careworkers from NorthernItaly basedonantibodystatus:
immuneprotectionfrom secondaryinfection-Aretrospective observational case-controlled study
https://doi.org/10.1016/j.ijid.2021.07.003
● This observational prospective cohort study can provide the evidence for the impact of s eropositive and
seronegative SARS-CoV-2 antibodies to the COVID-19 outcome, but still needed another study to
increase evidence by conducting a systematic review or meta-analysis of several existing studies.
 CRITICAL APPRAISAL SUMMARY
VALIDITY
The research focus is in line with the research objectives. Subjects, data, and analysis of
research data are appropriate even though it is carried out in 1 center only.

IMPORTANCE
This study assessed the relative incidence of people who were confirmed to be PCR
positive and had symptoms of infection in health workers in relation to antibody
seropositive and seronegative values. This is useful for determining the prognosis of SARS-
CoV-2 reinfection patients.

APPLICABILITY
The results of this study can be applied but differences can be obtained due to differences
in race, envinromental, and variants of SARS CoV-2.