Study Design Retrospective Chart Review Vs Case Control

OVERVIEW

• Retrospective studies are designed to analyse pre-existing data, and are subject to numerous biases as a effect
• Retrospective studies may exist based on chart reviews (data collection from the medical records of patients)
• Types of retrospective studies include:
  • example series
  • retrospective accomplice studies (current or historical cohorts)
  • case-control studies

STATISTICAL Analysis USED IN RETROSPECTIVE STUDIES

• Unadjusted, univariate, 'simple' or 'raw' analysis
  • Compare outcomes between treatment and control group
  • Used if treatment and control grouping are selected past a chance mechanism
• Stratified analysis
  • Separate all patients into subgroups according to a gamble factor, then perform comparison within these subgroups
  • Used if simply one primal confounding variable exists
• Matched pair analysis
  • Notice pairs of patients that have specific characteristics in common, but received different treatments; compares outcome only in these pairs
  • Used if just a few confounders exist and if the size of one of the comparison groups is much larger than the other
• Multivariate analysis
  • More one confounder is controlled simultaneously, if a larger number of confounders needs to be adjusted for computer software and statistical advice is necessary
  • Used if sample size is big
• No statistical analysis
  • Unproblematic description of data
  • Used if sample size is depression and other options failed

ADVANTAGES OF RETROSPECTIVE STUDIES

• quicker, cheaper and easier than prospective cohort studies
• can address rare diseases and identify potential hazard factors (east.g. instance-command studies)
• not decumbent to loss of follow up
• may be used as the initial study generating hypotheses to be studied further by larger, more expensive prospective studies

DISADVANTAGES OF RETROSPECTIVE STUDIES

• inferior level of evidence compared with prospective studies
• controls are frequently recruited by convenience sampling, and are thus not representative of the full general population and decumbent to selection bias
• prone to recollect bias or misclassification bias
• subject to confounding (other risk factors may be present that were not measured)
• cannot decide causation, only association
• some primal statistics cannot exist measured
• temporal relationships are often difficult to assess
• retrospective cohort studies need large sample sizes if outcomes are rare

SOURCES OF ERROR IN Nautical chart REVIEWS AND THEIR SOLUTIONS

From Kaji et al (2014) and Gilbert et al (1996):

• Chart review inappropriate for study question
  • plant whether necessary information is available in the charts
  • establish if there are sufficient charts to perform the analysis with adequate precision
  • perform a sample size calculation
• Investigator disharmonize of interest or bias
  • Declare any conflict of interest
    Provide evidence of institutional review board blessing
  • Submit the data collection form, every bit well as the coding rules and definitions, as an online appendix
• Patient sample is not-representative
  • Case selection or exclusion using explicit protocols and well described the criteria
  • Ensure all available charts have an equal take chances of pick
  • Provide a menstruum diagram showing how the written report sample was derive from the source population
• Needed variables are not in the records
  • define the predictor and outcome variables to be collected a priori
  • Develop a coding manual and publish as an online appendix
• Nautical chart abstraction is not systematic (misclassification bias)
  • Use standardized abstraction forms to guide information collection
  • Provide precise definitions of variables
  • Pilot test the abstraction grade
• Presence of missing or conflicting information
  • Ensure uniform handling of information that is conflicting, ambiguous, missing, or unknown
  • Perform a sensitivity analysis if needed
• Abstractors biased or not blinded
  • Bullheaded nautical chart reviewers to the etiologic relation existence studied or the hypotheses being tested. If groups of patients are to be compared, the abstractor should be blinded to the patient's group assignment
  • Depict how blinding was maintained in the article
• Abstractors not sufficiently trained
  • Train chart abstractors to perform their jobs.
  • Draw the qualifications and preparation of the chart abstracters.
  • Ideally, train abstractors before the written report starts, using a prepare of "practice" medical records.
  • Ensure uniform training, peculiarly in multi-middle studies
• Abstractors not sufficiently monitored
  • Monitor the functioning of the nautical chart abstractors
  • Agree periodic meetings with chart abstractors and written report coordinators to resolve disputes and review coding rules.
• Nautical chart brainchild unreliable
  • A second reviewer should re-abstract a sample of charts, blinded to the information obtained by the first correlation reviewer.
  • Report a kappa-statistic, intraclass coefficient, or other measure of agreement to assess inter-rater reliability of the data
  • Provide justification for the criteria for each variable

SOURCES OF ERROR FROM THE Employ OF ELECTRONIC MEDICAL RECORDS

Potential biases introduced from:

• use of boilerplates (a unit of writing that can exist reused over and over without alter)
• items copied and pasted
• default tick boxes
• delays in time stamps relative to actual intendance

References and Links

LITFL

• CCC — Case-command studies

Journal articles

• Gilbert EH, Lowenstein SR, Koziol-McLain J, Barta DC, Steiner J. Chart reviews in emergency medicine research: Where are the methods? Ann Emerg Med. 1996 Mar;27(3):305-8. PMID: 8599488.
• Kaji AH, Schriger D, Green South. Looking through the retrospectoscope: reducing bias in emergency medicine chart review studies. Ann Emerg Med. 2014 Sep;64(3):292-8. PMID: 24746846.
• Sauerland Southward, Lefering R, Neugebauer EA. Retrospective clinical studies in surgery: potentials and pitfalls. J Hand Surg Br. 2002 Apr;27(2):117-21. PMID: 12027483.
• Worster A, Bledsoe RD, Cleve P, Fernandes CM, Upadhye S, Eva K. Reassessing the methods of medical record review studies in emergency medicine research. Ann Emerg Med. 2005 Apr;45(4):448-51. PMID: 15795729.

Chris Nickson

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is besides the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Offshoot Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Intendance Foundation and is a First Office Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical caste at the Academy of Auckland, he continued post-graduate training in New Zealand too as Australia's Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive intendance medicine and emergency medicine, likewise every bit mail-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient intendance and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU'southward teaching and simulation programmes and runs the unit's education website, INTENSIVE.  He created the 'Critically Sick Airway' class and teaches on numerous courses around the world. He is i of the founders of the FOAM motility (Free Open-Access Medical didactics) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology form, and the SMACC conference.

His one corking accomplishment is being the male parent of 2 astonishing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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Source: https://litfl.com/retrospective-studies-and-chart-reviews/

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