Is the Simplicity of the Evidence Pyramid Actually Detrimental for Understanding Evidence?

Annette O'ConnorBVSc, MVSc, DVSc, FANZCVS1

1Iowa State University, College of Veterinary Medicine, Iowa City, IA 52242, USA
*Corresponding Author (

Vol 2, Issue 1 (2017)

Published: 16 Feb 2019

DOI: 10.18849/VE.V2I1.100

The evidence pyramid for assessing the efficacy of interventions under real world conditions has been used in various forms for many years, and to a lesser extent the pyramid has been used for assessing evidence for disease risk factors. While acknowledging minor differences, many pyramids list the following information sources for interventions in decreasing order of “validity”: systematic review and meta-analysis of randomised control trials, randomised controlled trials, cohort studies, case control studies, case series and case reports.

In this presentation Annette discusses the validity of the evidence pyramid on the interpretation of evidence from primary research. She proposes a new way to think about evidence from primary studies using the framework for classifying epidemiologic studies proposed by Pearce (2012) based on incident and prevalent cases. This would also result in a rethinking of the current evidence pyramid.

Find out more about Annette.


Open Access