Surgeons are widely regarded as the monarchs of medicine. Their intellectual brilliance and manual dexterity may indeed be outstanding but there is one vital aspect of healthcare in which they lag behind the medical profession as a whole: research.

Issues with registration of clinical trials

Pilot trials are exploratory studies limited in size and scope that give insight into the actions, efficacy, and safety of a drug or device but cannot provide definitive support for specific mechanistic or therapeutic claims. I feel it is important to appreciate their appropriate use and key limitations for clinical and translational cardiovascular research.

Identified methodological problems were an unclear understanding of underlying assumptions, inappropriate search and selection of relevant trials, use of inappropriate or flawed methods, lack of objective and validated methods to assess or improve trial similarity, and inadequate comparison or inappropriate combination of direct and indirect evidence. Adequate understanding of basic assumptions underlying indirect and mixed treatment comparison is crucial to resolve these methodological problems.

This Review presents a 10-step guide to critical appraisal that aims to assist clinicians to identify the most relevant high-quality studies available to guide their clinical practice.