CASP Checklist: 11 questions to help you make sense of a Case Control Study
How to use this appraisal tool: Three broad issues need to be considered when appraising a
case control study:
Are the results of the study valid? (Section
A) What are the results?
(Section B) Will the results help locally?
(Section C)
The 11 questions on the following pages are designed to help you think about these issues
systematically. The first three 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 “can’t 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.
About: These checklists were designed to be used as educational pedagogic tools, as part of
a workshop setting, therefore we do not suggest a scoring system. The core CASP checklists
(randomised controlled trial & systematic review) were based on JAMA 'Users’ guides to
the medical literature 1994 (adapted from Guyatt GH, Sackett DL, and Cook DJ), and
piloted with health care practitioners.
For each new checklist, a group of experts were assembled to develop and pilot the checklist
and the workshop format with which it would be used. Over the years overall adjustments
have been made to the format, but a recent survey of checklist users reiterated that the basic
format continues to be useful and appropriate.
Referencing: we recommend using the Harvard style citation, i.e.: Critical Appraisal Skills
Programme (2018). CASP (insert name of checklist i.e. Case Control Study) Checklist.
[online] Available at: URL. Accessed: Date Accessed.
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Paper for appraisal and reference:
Section A: Are the results of the trial valid?
1. Did the study address a Yes HINT: An issue can be ‘focused’ In terms of
clearly focused issue? • the population studied
Can’t Tell • Whether the study tried to detect a
beneficial or harmful effect
No • the risk factors studied
Comments: 1. Peneliti tidak menjelaskan populasi yang menjadi tempat penelitian
2.Kriteria inklusi dan esklusi sudah dipaparkan
3.Fokus dan tujuan nya jelas
2. Did the authors use an Yes HINT: Consider
appropriate method to • Is a case control study an appropriate
answer their question? Can’t way of answering the question under
Tell
the circumstances
No • Did it address the study question
Comments: peneliti sudah tepat menggunakan metode case control guna membandingkan antara
Pasien stroke dengan pasien tidak stroke dengan faktor resiko yang sama
2
Is it worth continuing?
3. Were the cases recruited in Yes HINT: We are looking for selection
an acceptable way? bias which might compromise validity
of the
Can’t findings
Tell • are the cases defined precisely
• were the cases representative of a
No defined population (geographically
and/or temporally)
Comments: 1. Peneliti • was there an established reliable
tidak menjelaskan system for selecting all the cases
pertimbangan • are they incident or prevalent
mengambil tempat • is there something special about the
penelitian tersebut cases
• is the time frame of the study
relevant to disease/exposure
• was there a sufficient number of
cases selected
• was there a power calculation
4. Were the controls selected in Yes HINT: We are looking for selecti
an acceptable way? bias
Can’t Tell which might compromise
generalisability of the fin
• were the controls representative of
No defined population (geograph
and/or tempo
• was there something special about
Comments: Jumlah responden dan kontrol berbeda the controls
• was the non-response high, could
non-respondents be different in
any way
• are they matched, population
based or randomly selected
• was there a sufficient number of
controls selected
3
5. Was the exposure accurately Yes HINT: We are looking for
measured to minimise bias? measurement, recall or
classification bias
Can’t • was the exposure clearly defined and
Tell accurately measured
• did the authors use subjective or
No objective measurements
• do the measures truly reflect what
Comments: they are supposed to measure (have
Tidak they been validated)
dijelaskan • were the measurement methods
similar in the cases and controls
• did the study incorporate blinding
where feasible
• is the temporal relation correct
(does the exposure of interest
precede the outcome)
6. (a) Aside from the HINT: List the ones you think might
experimental intervention, be important, that the author may
were the groups treated have missed
equally?
• genetic
• environmental
• socio-economic
List: faktor keturunan,Faktor penyakit penyerta
6. (b) Have the authors taken Yes HINT: Look for
account of the potential • restriction in design, and techniques e.g.
confounding factors in the Can’t modelling, stratified-, regression-, or
design and/or in their Tell sensitivity analysis to correct, control or
analysis? adjust for confounding factors
No
Comments: Tidak dijelaskan faktor yang dapat menjadi perancu pada penelitian ini
4
Section B: What are the results?
7. How large was the treatment effect? HINT: Consider
• what are the bottom line
results
• is the analysis appropriate to
the design
Comments: • how strong is the association
Terdapat between exposure and
beberapa outcome (look at the odds
faktor yang ratio)
berkaitan • are the results adjusted for
dengan confounding, and might
stroke confounding still explain the
association
• has adjustment made a big
difference to the OR
8. How precise was the estimate of the treatment HINT: Consider
effect? • size of the p-value
• size of the confidence intervals
• have the authors considered all the
important variables
• how was the effect of subjects
refusing to participate evaluated
Comments: Uji statistik Chi Square with Yates Correction didapatkan hasil terdapat hubungan bermakna
antara hipertensi, diabetes, jenis kelamin, pekerjaan, status pernikahan, dan kelompok usia 60
tahun keatas terhadap kejadian stroke (p-value: < 0,05)
5
9. Do you believe the results? Yes v HINT: Consider
• big effect is hard to ignore!
• Can it be due to chance, bias, or
No confounding
• are the design and methods of this
study sufficiently flawed to make the
results unreliable
• consider Bradford Hills criteria (e.g.
time sequence, does-response
gradient, strength, biological
plausibility)
Comments: Faktor resikoya yang dihubungan dengan terjadinya stroke sudah sesuai teori
Section C: Will the results help locally?
10. Can the results be applied Yes HINT: Consider whether
to the local population? • the subjects covered in the study could
Can’t Tell be sufficiently different from your
population to cause concern
No • your local setting is likely to
differ much from that of the
study
• can you quantify the local benefits and
harms
Comments: Dengan penelitian ini dapat merubah kebiasaan yang dapat menyebab kan stroke
11. Do the results of this study Yes HINT: Consider
fit with other available • all the available evidence from RCT’s
evidence? Can’t Systematic Reviews, Cohort
Tell Studies, and Case Control Studies as
well, for consistency
No
Comments: Sesuai dengan Teori
Remember One observational study rarely provides sufficiently robust evidence to recommend changes to
clinical practice or within health policy decision making. However, for certain questions observational
studies provide the only evidence. Recommendations from observational studies are always stronger
when supported by other evidence.
