JBJS levels of evidence

Introducing levels of evidence to the journal

Wright JG, Swiontkowski MF, Heckman JD The Journal of bone and joint surgery. American volume 2003 · PMID 12533564 · doi:10.2106/00004623-200301000-00001

Question

How should published orthopaedic studies be graded by the strength of their evidence?

Design

Editorial introducing a level-of-evidence rating for all clinical articles in JBJS (American volume).

Patients

Clinical studies published in the journal.

Intervention

Levels I-V grading by study type (therapeutic, prognostic, diagnostic, economic)

Comparison

No formal grading

Primary outcome

Not applicable

Key result

Introduced a five-level hierarchy, from high-quality RCTs (level I) to expert opinion (level V), applied separately to therapeutic, prognostic, diagnostic and economic studies.

Limitations

Grades study design rather than study quality; a poorly conducted RCT can still be labelled level I or II.

Impact on practice

Levels of evidence are now printed on most orthopaedic papers and are routinely examined; trainees should be able to assign a level and recognise its limits.