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Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS)
  1. Martin J Downes1,
  2. Marnie L Brennan2,
  3. Hywel C Williams3,
  4. Rachel S Dean2
  1. 1Centre for Applied Health Economics, School of Medicine, Griffith University, Meadowbrook, Queensland, Australia
  2. 2Centre for Evidence-based Veterinary Medicine, The University of Nottingham, Loughborough, UK
  3. 3Centre of Evidence Based Dermatology, The University of Nottingham, Nottingham, UK
  1. Correspondence to Dr Rachel S Dean; rachel.dean{at}nottingham.ac.uk

Abstract

Objectives The aim of this study was to develop a critical appraisal (CA) tool that addressed study design and reporting quality as well as the risk of bias in cross-sectional studies (CSSs). In addition, the aim was to produce a help document to guide the non-expert user through the tool.

Design An initial scoping review of the published literature and key epidemiological texts was undertaken prior to the formation of a Delphi panel to establish key components for a CA tool for CSSs. A consensus of 80% was required from the Delphi panel for any component to be included in the final tool.

Results An initial list of 39 components was identified through examination of existing resources. An international Delphi panel of 18 medical and veterinary experts was established. After 3 rounds of the Delphi process, the Appraisal tool for Cross-Sectional Studies (AXIS tool) was developed by consensus and consisted of 20 components. A detailed explanatory document was also developed with the tool, giving expanded explanation of each question and providing simple interpretations and examples of the epidemiological concepts being examined in each question to aid non-expert users.

Conclusions CA of the literature is a vital step in evidence synthesis and therefore evidence-based decision-making in a number of different disciplines. The AXIS tool is therefore unique and was developed in a way that it can be used across disciplines to aid the inclusion of CSSs in systematic reviews, guidelines and clinical decision-making.

  • Cross sectional studies
  • Critical appraisal
  • Evidence-based Healthcare
  • Delphi

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • MJD, MLB and RSD contributed equally to this work.

  • Twitter Follow Rachel Dean at @CEVetM

  • Contributors MJD, MLB and RSD made substantial contribution to the conception and design of the work, as well as the acquisition, analysis or interpretation of data. They were directly involved in the preparation and revision of the intellectual content of the manuscript submitted for publication. They will be involved in the final approval of the manuscript prior to publication and agree to be accountable for all aspect of the work. HCW made substantial contribution to the conception and design of the work, interpretation of data and the preparation and revision of the intellectual content of the manuscript submitted for publication. He will be involved in the final approval of the manuscript prior to publication and agrees to be accountable for all aspect of the work.

  • Funding The Centre for Evidence-based Veterinary Medicine and this project was supported by an unrestrictive grant from Elanco Animal Health and The University of Nottingham.

  • Competing interests None declared.

  • Ethics approval The ethics committee at the School of Veterinary Medicine and Science, The University of Nottingham reviewed and approved this study. Written consent (via email) from the panellists was received by the authors following invitation to be included in the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors are willing to share any of the data collected during the Delphi process that are not in this published manuscript or the online supplementary material.

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