An alphabet soup

EQUATOR Network.

equator network

EQUATOR Network includes a series of statements or directives that different epidemiological designs must comply with.

Unfortunately, much of the times we think we can do a little research work, the only thing that moves us is the interest in swell the account of our curriculum or we do it only because we like seeing our name in a publication or conference’s book.

So, it’s not surprising that much of the work that are published are, to put it mildly and politely, of poor quality, in a way that we don’t know how they are made, or if they are reliable or bring any innovation, not to talk about how we use them in the context of our medical knowledge.

And this not only has to do with getting the work done, but there’re often defects in the way of publication and dissemination of results, it may happen that part of its methodology be hidden, or that the paper doesn’t discuss about the harmful or negative effects. In summary, we may publish only what we’re interested in.

But do not despair. To remedy this sad situation we can use an alphabet soup. And I’m not thinking about food, but about another soup combining letters in an unimaginable number of impossible names to call lists of recommendations and checklists that allow us to order the entire process of creation and dissemination of scientific work without committing methodological errors or omissions in the process.


It all started with a program of the Health Service of the United Kingdom that ended with the founding of an international initiative to promote transparency and accuracy of the work of biomedical research: the EQUATOR (Enhancing the Quality and Transparency Of health Research) Network.

This network consists of experts in methodology, communication and publication, including professionals involved in the quality of the whole process of production and dissemination of research results. Among many other objectives, which you can see on their website, they’ve designed a set of recommendations for the completion and publication of the various types of studies, leading to different checklists or statements discussed below.


Perhaps the most widespread is the CONSORT statement (CONsolidated Standards Of Reporting Trials), which addresses aspects of design, performing, analysis, validity and interpretation of randomized clinical trials. It consists of a checklist (which checks the tittle’s content, abstract, introduction, methods, results, discussion and other information such as trial’s data registry) and a flow chart (which describes the flow followed by all the participants throughout the study).


CONSORT has many extensions for trials with different types of design (groups, non-inferiority and equivalence, pragmatic), intervention (treatment with herbs, non-pharmacologic, occupational and even acupuncture, homeopathic, etc.) or data type (damage, abstracts, etc.).

For those who want more information, there is an unofficial extensions catalog which is available online and is updated periodically. In addition, the TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) statement has been designed for non-randomized clinical trials.

Observational studies

STROBE (Strengthening The Reporting of OBservational studies in Epidemiology) statement handles with observational studies, especially cohort studies, case-control studies and cross-sectional studies. However, in a similar way to what happened with CONSORT, STROBE has many close relatives to control the methodology of observational studies of specific types, as STREGA (genetic linkage studies), ORION (infection control) and many others to series of cases, longitudinal studies, etc. These checklists are available on the website of the STROBE statement.

Another of the most widespread is the STARD statement (STAndards for the Reporting of Diagnostic accuracy studies), who devotes its efforts to improve the accuracy of studies of diagnostic tests to allow a proper assessment of its internal and external validity.

Like CONSORT, it consists of a checklist and a flow diagram that describes the study design and patient flow. A statement of similar utility is the QUADAS (QUality Assessment of Diagnostic Accuracy Studies), which focuses specifically on aspects of accuracy of diagnostic test studies included in systematic reviews.


And talking about systematic reviews, we could not miss a statement for them: PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement, which will replace the QUOROM (QUality Of Reporting Of Meta-analyzes) statement.

Based on the definition of systematic review by the Cochrane Collaboration, PRISMA helps us to select, identify and assess the studies included in the review. It also consists of a checklist and a flow diagram in which the passage of all trials considered while performing the review is described. There is also a less known statement for the assessment of meta-analysis of observational studies, the MOOSE (Meta-analyzes Of Observational Studies in Epidemiology) statement.

And more…

And the list goes on: COREQ statement (COnsolidated criteria for REporting Qualitative research) for qualitative research studies, ISPOR RCT-CEA for cost-effectiveness studies and economic evaluation, SQUIRE (Standards for QUality Improvement Reporting Excellence) for studies of quality of life and improved health, aGREE (Appraisal of Guidelines REsearch and Evaluation) for conducting clinical practice guidelines, GRRS (Guidelines for Reporting Reliability and agreement Studies) for studies of reliability and agreement, etc, etc.

The truth is that you cannot deny that the thing has a great merit, and I’m talking about those who invented all these imaginative names for those different lists and statements.

Now what it’s needed is that their effort and also the one of those who made the statements, is rewarded with its implementation so the research works will more useful to allow to improve our clinical practice, and less to swell our curriculum or to promote new products. Many biomedical journals have subscribed these statements, so they only publish papers that meet all the point of the related checklist, for example, the CONSORT for clinical trials.

We’re leaving…

Finally, just say that all these checklists that help the researcher to perform the work or the editor to decide if it’s worth publishing, may also serve us, mere consumers of medical literature, to assess the validity of the studies and to avoid wasting time reading works that are not going to contribute to anything useful. Checklists can be used as tools for critical appraising of scientific papers, as it is done with CASP templates or other resources. But that’s another story…

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