Introduction to critically appraised topics (CATs)

Equine veterinarians and BEVA have flirted with the concept of evidence-based medicine since it became fashionable around 15 years ago. Evidence-based medicine can be defined in various ways but one of the more popular definitions was coined by Professor Sackett as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients”[1]. Supporters emphasise the importance of using quantitative evidence from well-designed clinical and epidemiology studies to inform clinical practice.
In 2003, Dr Peter Rossdale, a life-long advocate of the benefits of applying science to clinical practice, introduced a fast track section in Equine Veterinary Journal to encourage authors both in their methodology and reporting to assist in the development of evidence-based medicine [2]. But yet, the first – and to date only – systematic review of efficacy of an equine therapy did not appear in Equine Veterinary Journal for a further 9 years [3]. In the same issue, Professor Burton, pointed out that veterinary medicine could justifiably be accused, like human medicine, of failing to cumulate evidence scientifically [4].
So what’s the problem? The easiest answer would be to simply say, “there is no evidence, we can’t do it!” And, if we demand that systematic review of randomised clinical trials is the only evidence we can accept for therapeutic decision making, that would be a reasonable stance. But that approach might be said to be “throwing the baby out with the bath water”. As clinicians, we know we do not live in a perfect world. If we do not have evidence that reaches the top of the hierarchy of evidence [5], then we must be prepared to critically appraise, and where possible, apply the evidence we do have from studies that sit lower on that pyramid.[…]