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Methodological quality of case series studies: an introduction to the JBI critical appraisal tool
Abstract
INTRODUCTION: Systematic reviews provide a rigorous synthesis of the best available evidence regarding a certain question. Where high-quality evidence is lacking, systematic reviewers may choose to rely on case series studies to provide information in relation to their question. However, to date there has been limited guidance on how to incorporate case series studies within systematic reviews assessing the effectiveness of an intervention, particularly with reference to assessing the methodological quality or risk of bias of these studies. METHODS: An international working group was formed to review the methodological literature regarding case series as a form of evidence for inclusion in systematic reviews. The group then developed a critical appraisal tool based on the epidemiological literature relating to bias within these studies. This was then piloted, reviewed, and approved by JBI's international Scientific Committee. RESULTS: The JBI critical appraisal tool for case series studies includes 10 questions addressing the internal validity and risk of bias of case series designs, particularly confounding, selection, and information bias, in addition to the importance of clear reporting. CONCLUSION: In certain situations, case series designs may represent the best available evidence to inform clinical practice. The JBI critical appraisal tool for case series offers systematic reviewers an approved method to assess the methodological quality of these studies.
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“We consider to use the ROB II tool 22 for RCTs and the ROBINS-I tool 23 for quasiexperimental and controlled cohort studies. Uncontrolled cohort studies were assessed using a tool, developed by our team, to assess the risk of bias in series of subjects exposed to an intervention (see Supplementary Appendix 3). Case series were evaluated using the Joanna Briggs Institute checklist 24.”
From Efectividad del tratamiento de la sífilis gestacional en el último trimestre sobre la incidencia de sífilis congénita: revisión sistemática y metanálisis (2025) · cites this paper as [24]
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Self-citationJBI's Systematic Reviews: Study Selection and Critical Appraisal
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Self-citationThe updated Joanna Briggs Institute Model of Evidence-Based Healthcare
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Silva, M. H. A., Dantas, T. H. D. M., Araújo, A. C. D. M., Dantas, D. D. S., Dantas, M. I. D. A., de Lucena, B. C. M., Moura, I. C. R. R., & Fernandes, A. B. G. S. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22081277 · Cited by 4
Li, Z., Fang, P., Shen, S., Zhang, L., Xie, R., & Li, C. (2025) · Frontiers in Oncology · doi:10.3389/fonc.2025.1703261 · Cited by 4
Yousif, E., Abdalla, M., Jumaa, H., Fadlelmola, S., Haboura, O., Abdelrahim, A., Elsayed, A. A., & Abdelrahim, M. A. (2025) · Cureus · doi:10.7759/cureus.98224 · Cited by 4
“The quality of the studies included was evaluated for possible bias using the Joanna Briggs Institute critical appraisal checklists (https://jbi.global/critical-appraisal-tools) [9 ].”
Reed, J. C., Wollenman, C. C., Tisano, B., Dale, K. M., & LeClere, L. E. (2026) · The American Journal of Sports Medicine · doi:10.1177/03635465251383851 · Cited by 4
Dunah, M. B., Abdalla, M. A., Wawata, I. G., & Tijani, N. A. (2026) · Frontiers in Microbiology · doi:10.3389/fmicb.2025.1673235 · Cited by 4
“Studies were included if they met the following criteria: 1.”
InfluentialLupus podocytopathy: A systematic review of clinical evidence from cases and cohorts
Wang, Q., Basharat, B., Sun, K., Subedi, R., Artiles, M. J., & Ballou, S. P. (2026) · Lupus · doi:10.1177/09612033261415986 · Cited by 4
“We used JBI case report checklists and JBI case series checklists 26 for the included case reports, case series and cohort studies.”
Chiari, F., Dalmazzini, C., Fermi, M., Presutti, L., Caporale, C. D., & Guarino, P. (2026) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-026-10313-w · Cited by 4
“To further validate the inclusion of studies with low or moderate risk of bias, the Joanna Briggs Institute Critical Appraisal Tools was applied [22], ensuring the methodological robustness and reliability of the selected studies.”
Mapping menopause education for healthcare professionals: a scoping review
Keye, C., Murphy, M., Saab, M. M., & O’Driscoll, M. (2026) · Climacteric · doi:10.1080/13697137.2026.2676683 · Cited by 4
“titles and abstracts were screened against the eligibility criteria, with potentially relevant studies advanced to full-text review. included papers met all criteria, and exclusions were documented. covidence online software was used to remove duplicates [30].”
InfluentialStereotactic radiosurgery for intraventricular meningioma: a systematic review and meta-analysis
Khaboushan, A. S., Ohadi, M. A. D., Amani, H., Dashtkoohi, M., Iranmehr, A., & Sheehan, J. P. (2024) · Acta Neurochirurgica · doi:10.1007/s00701-024-06185-w · Cited by 4
Efficacy of immunotherapy in RET fusion-positive NSCLC: A meta-analysis
Peng, Z., Ding, K., Xie, M., & Xu, Y. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e34626 · Cited by 4
Pruski, M., O'Connell, S. M., Knight, L., & Morris, R. (2024) · Applied Health Economics and Health Policy · doi:10.1007/s40258-024-00903-2 · Cited by 4
Fan, L., Stewart, F. J., Ruiz, K., Devani, D., Fusco, N., Gill, M., Amber, V., Su, W., Gangi, A., & Hanvesakul, R. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e36883 · Cited by 4
Terlizzi, V., Ballerini, T., Castaldo, A., Dolce, D., Campana, S., Taccetti, G., & Chiappini, E. (2024) · BMC Pulmonary Medicine · doi:10.1186/s12890-024-03217-0 · Cited by 4
Goodwin, B. J., Mitchell, J., Major, E., Podwójniak, A., Brancaccio, H., Rusinak, K., King, M., & Tahir, H. (2024) · Pain Management · doi:10.1080/17581869.2024.2433931 · Cited by 4
Excipient induced allergies in oral medications: unravelling the covert threat – a systematic review
Seth, S., Lukose, L., Sud, K., Goh, J. X., Tesfaye, W. H., Small, F., Sridhar, S. B., & Castelino, R. L. (2024) · Internal Medicine Journal · doi:10.1111/imj.16605 · Cited by 4
Aggressive Subtypes of Laryngeal Chondrosarcoma and their Clinical Behavior: A Systematic Review
Piazza, C., Montenegro, C., Tomasoni, M., Leivo, I. V. V., Stenman, G., Agaimy, A., Simpson, R. H. W., Zidar, N., & Ferlito, A. (2025) · Oncology and Therapy · doi:10.1007/s40487-024-00323-1 · Cited by 4
Metadata
- Authors
- Munn, Z., Barker, T. H., Moola, S., Tufanaru, C., Stern, C., McArthur, A., Stephenson, M., & Aromataris, E.
- Affiliations
- The University of Adelaide (AU)
- Corresponding author
- Barker, Timothy Hugh
- ORCID
- Venue
- JBI Database of Systematic Reviews and Implementation Reports
- Published
- 2019-09-23
- Volume
- Publish Ahead of Print
- Issue
- 10
- Pages
- 2127-2133
- ISSN
- 2202-4433 (ISSN-L)
- OpenAlex
- W2974663997
- Cited by
- 1,581
- References
- 31
- Citations by year
- 2026: 404 · 2025: 392 · 2024: 317 · 2023: 230 · 2022: 142 · 2021: 83 · 2020: 13
- FWCI
- 39.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The JBI Database of Systematic Reviews and Implementation Reports (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Health Sciences › Nursing › Research and Theory › Methodologies in Health Research and Practice
- Keywords
- methodological quality, risk of bias, critical appraisal tools, internal validity, confounding, selection bias, information bias, reporting quality, evidence synthesis, systematic reviews
- MeSH terms
- Systematic Reviews as Topic, Research Design, Bias
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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