Comments on “Criteria for selection and classification of studies in medical events”

Vieira et al.¹ evaluated the impact of study methodology and evaluation type on the selection of studies during the presentation of scientific events. This article highlighted something worrying for the health sciences in medical events: “The evidence pyramid rule².” After the inception of the evidence-based health movement in the 1990s, the evidence pyramid rose from the mud². Inherent in this pyramid is the concept of a hierarchy (less valid evidence is at the bottom of the pyramid and more valid at the top). Thus, a search for an answer to a clinical question should begin at the top of the pyramid (i.e., systematic reviews with meta-analyses of randomized controlled trials)².

Systematic reviews with meta-analyses of randomized controlled trials are important to show whether an intervention is effective/efficacy; however, it is important to emphasize that the clinical research question is not always about the effectiveness/efficacy of an intervention. Namely, in some cases, patients and professionals may want to know the risk, prevalence, incidence, or symptoms of a disease but a systematic review with meta-analyses of randomized controlled trials does not reveal these details. Therefore, it is important first to analyze the clinical question in order to decide which is the best study design. Furthermore, there is not just one evidence pyramid³,⁴.

• Funding: This study was funded by the São Paulo Research Foundation (FAPESP, grant 2022/08646-6); and partially supported by the Coordination for the Improvement of Higher Education Personnel (CAPES, code 001). The funding source had no role in the study design, collection, analysis, interpretation of data, writing of the report, or in the decision to submit the article for publication.

ACKNOWLEDGMENTS

I would like to thank the Coordination for the Improvement of Higher Education Personnel (CAPES); National Council for Scientific and Technological Development (CNPq); São Paulo Research Foundation (FAPESP); Federal University of Maranhão (UFMA); Federal University of São Carlos (UFSCar); Almir Vieira Dibai-Filho, PhD; and Maria de Fátima Pontes-Silva.

REFERENCES

• ¹
  Vieira RADC, Paulinellli RR, Rodrigues FFO, Moreira MAR, Caponero R, Pessoa EC, et al. Criteria for selection and classification of studies in medical events. Rev Assoc Med Bras. 2023;69(4):e20220888. https://doi.org/10.1590/1806-9282.20220888
  » https://doi.org/10.1590/1806-9282.20220888
• ²
  Shaneyfelt T. Pyramids are guides not rules: the evolution of the evidence pyramid. Evid Based Med. 2016;21(4):121-2. https://doi.org/10.1136/ebmed-2016-110498
  » https://doi.org/10.1136/ebmed-2016-110498
• ³
  Tugwell P, Knottnerus JA. Is the “Evidence-Pyramid” now dead?. J Clin Epidemiol. 2015;68(11):1247-50. https://doi.org/10.1016/j.jclinepi.2015.10.001
  » https://doi.org/10.1016/j.jclinepi.2015.10.001
• ⁴
  Murad MH, Asi N, Alsawas M, Alahdab F. New evidence pyramid. Evid Based Med. 2016;21(4):125-7. https://doi.org/10.1136/ebmed-2016-110401
  » https://doi.org/10.1136/ebmed-2016-110401

Publication Dates

• Publication in this collection
  14 Aug 2023
• Date of issue
  2023

History

• Received
  12 May 2023
• Accepted
  21 May 2023