CASP Cohort

12 questions to help you make sense of cohort study
How to use this appraisal tool

Three broad issues need to be considered when appraising a cohort study:
Are the results of the study valid?

What are the results?
Will the results help locally?
(Section A)
(Section B)
(Section C)
The 12 questions on the following pages are designed to help you think about these issues systematically.
The first two 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 cant
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.
These checklists were designed to be used as educational tools as part of a workshop setting
There will not be time in the small groups to answer them all in detail!
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Critical Appraisal Skills Programme (CASP) Cohort Study Checklist 31.05.13
(A) Are the results of the study valid?

Screening Questions
1. Did the study address a clearly focused issue?
Yes Cant tell No
HINT: A question can be focused In terms of

The population studied
The risk factors studied
The outcomes considered
Is it clear whether the study tried to detect a beneficial
or harmful effect?
2. Was the cohort recruited in an acceptable way?
Yes Cant tell No
HINT: Look for selection bias which might compromise

the generalisibility of the findings:
Was the cohort representative of a defined population?
Was there something special about the cohort?
Was everybody included who should have been included?
Is it worth continuing?
Detailed questions
3. Was the exposure accurately measured to
Yes
Cant tell No
Yes
Cant tell No
minimise bias?
HINT: Look for measurement or classification bias:
Did they use subjective or objective measurements?
Do the measurements truly reflect what you want them
to (have they been validated)?
Were all the subjects classified into exposure groups
using the same procedure
4. Was the outcome accurately measured to

minimise bias?
HINT: Look for measurement or classification bias:
Did they use subjective or objective measurements?
Do the measures truly reflect what you want them to
(have they been validated)?
Has a reliable system been established for
detecting all the cases (for measuring disease
occurrence)?
Were the measurement methods similar in the
different groups?
Were the subjects and/or the outcome assessor
blinded to exposure (does this matter)?
5. (a) Have the authors identified all important
Yes Cant tell No
confounding factors?
List the ones you think might be
important, that the author missed.
(b) Have they taken account of the

confounding factors in the design
and/or analysis?
Yes Cant tell No

List:
HINT: Look for restriction in design, and techniques e.g.

modelling, stratified-, regression-, or sensitivity analysis
to correct, control or adjust for confounding factors
6. (a) Was the follow up of subjects complete
Yes Cant tell No
enough?
(b) Was the follow up of subjects long
Yes Cant tell No
enough?
HINT: Consider
The good or bad effects should have had long enough
to reveal themselves
The persons that are lost to follow-up may have
different outcomes than those available for assessment
In an open or dynamic cohort, was there anything special
about the outcome of the people leaving, or the
exposure of the people entering the cohort?
(B) What are the results?

7. What are the results of this study?
HINT: Consider
What are the bottom line results?
Have they reported the rate or the proportion between
the exposed/unexposed, the ratio/the rate difference?
How strong is the association between exposure and
outcome (RR,)?
What is the absolute risk reduction (ARR)?
8. How precise are the results?

HINT: Look for the range of the confidence intervals, if given.
9. Do you believe the results?
Yes Cant tell No
HINT: Consider
Big effect is hard to ignore!
Can it be due to bias, chance or confounding?
Are the design and methods of this study sufficiently
flawed to make the results unreliable?
Bradford Hills criteria (e.g. time sequence, dose-response
gradient, biological plausibility, consistency)
(C) Will the results help locally?

10. Can the results be applied to the local population?
Yes Cant tell No
HINT: Consider whether
A cohort study was the appropriate method to answer this question

The subjects covered in this study could be sufficiently different from
your population to cause concern
Your local setting is likely to differ much from that of the study
You can quantify the local benefits and harms
11. Do the results of this study fit with other
Yes Cant tell No
available evidence?
12. What are the implications of this study for practice?

HINT: Consider
One observational study rarely provides sufficiently robust

evidence to recommend changes to clinical practice or
within health policy decision making
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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12 questions to help you make sense of cohort study

How to use this appraisal tool

Are the results of the study valid?

Critical Appraisal Skills Programme (CASP) Cohort Study Checklist 31.05.13

(A) Are the results of the study valid?

Yes Cant tell No

HINT: A question can be focused In terms of

2. Was the cohort recruited in an acceptable way?

Yes Cant tell No

HINT: Look for selection bias which might compromise

3. Was the exposure accurately measured to

4. Was the outcome accurately measured to

Critical Appraisal Skills Programme (CASP) Cohort Study Checklist 31.05.13

5. (a) Have the authors identified all important

Yes Cant tell No

(b) Have they taken account of the

Yes Cant tell No

HINT: Look for restriction in design, and techniques e.g.

6. (a) Was the follow up of subjects complete

Yes Cant tell No

(b) Was the follow up of subjects long

Yes Cant tell No

Critical Appraisal Skills Programme (CASP) Cohort Study Checklist 31.05.13

(B) What are the results?

8. How precise are the results?

9. Do you believe the results?

Yes Cant tell No

Critical Appraisal Skills Programme (CASP) Cohort Study Checklist 31.05.13

(C) Will the results help locally?

Yes Cant tell No

HINT: Consider whether

A cohort study was the appropriate method to answer this question

11. Do the results of this study fit with other

Yes Cant tell No

12. What are the implications of this study for practice?

One observational study rarely provides sufficiently robust

Critical Appraisal Skills Programme (CASP) Cohort Study Checklist 31.05.13

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