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A hierarchy of evidence, comprising levels of evidence (LOEs), that is, evidence levels (ELs), is a heuristic used to rank the relative strength of results obtained from experimental research, especially medical research. There is broad agreement on the relative strength of large-scale, epidemiological studies.
In 1965, the English statistician Sir Austin Bradford Hill proposed a set of nine criteria to provide epidemiologic evidence of a causal relationship between a presumed cause and an observed effect. (For example, he demonstrated the connection between cigarette smoking and lung cancer.) The list of the criteria is as follows: [1]
A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. [1] A systematic review extracts and interprets data from published studies on the topic (in the scientific literature), then analyzes, describes, critically appraises and summarizes interpretations into a refined evidence-based ...
Alternatively, one could group subjects based on their body mass index (BMI) and compare their risk of developing heart disease or cancer. Prospective cohort studies are typically ranked higher in the hierarchy of evidence than retrospective cohort studies [3] and can be more expensive than a case–control study. [4]
[1] [2] Hierarchy of study design, for example using a case-study, ecological study, cross-sectional, case-control, cohort, or experimental, although not always in this order is a general rule to a high "strength of evidence" of a clinical study. [3] [4] [5]
Given their intrinsic methodological limitations, including lack of statistical sampling, case reports are placed at the bottom of the hierarchy of clinical evidence, together with case series. [3] Nevertheless, case reports do have genuinely useful roles in medical research and evidence-based medicine. [4]
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Hierarchy of evidence in medicine. Evaluating scientific research is extremely complex. The process can be greatly simplified with the use of a heuristic that ranks the relative strengths of results obtained from scientific research, which is called a hierarchy of evidence.