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| Newcastle-Ottawa Scale | |
|---|---|
| Name | Newcastle-Ottawa Scale |
| Purpose | Quality assessment of nonrandomized studies in meta-analyses |
| Developed | 2000s |
| Creators | University of Newcastle upon Tyne; University of Ottawa |
| Type | Star-based assessment tool |
Newcastle-Ottawa Scale The Newcastle-Ottawa Scale is a star-based instrument developed to assess the methodological quality of nonrandomized studies, particularly cohort and case-control designs, used in meta-analyses and systematic reviews. It was created through collaboration between researchers at institutions associated with Newcastle upon Tyne and Ottawa and has been widely cited in literature from organizations and journals such as World Health Organization, Cochrane Collaboration, and The Lancet. The tool is commonly employed alongside reporting standards endorsed by bodies like International Committee of Medical Journal Editors and Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
The scale emerged during efforts to standardize quality appraisal across evidence syntheses conducted at centers including University of Newcastle upon Tyne and University of Ottawa and was influenced by methodological frameworks advanced at conferences such as the Cochrane Colloquium and meetings hosted by the National Institutes of Health. Early proponents included investigators affiliated with journals such as BMJ and JAMA who sought alternatives to instruments used by groups like Agency for Healthcare Research and Quality and U.S. Preventive Services Task Force. Over time the scale was disseminated through networks tied to World Health Organization training, workshops at Oxford University and guidelines by organizations such as European Society of Cardiology.
The instrument organizes assessment into domains adapted for cohort and case-control studies: selection, comparability, and exposure/outcome. Criteria were formulated with reference to standards advocated by committees like CONSORT and methods described in textbooks published by houses such as Oxford University Press and Cambridge University Press. Scoring assigns up to nine stars, reflecting judgments about representativeness of samples, ascertainment of exposure or outcome, and control for confounding by variables such as age, sex, or comorbidities recognized in clinical practice guidelines from bodies including American Heart Association, American Diabetes Association, and National Cancer Institute.
Researchers conducting systematic reviews in fields spanning oncology, cardiology, and epidemiology have applied the tool when pooling observational evidence in meta-analyses published in outlets like The New England Journal of Medicine, Circulation, and Annals of Internal Medicine. The scale is often used alongside databases and platforms such as PubMed, EMBASE, and Cochrane Library to screen and appraise eligible studies cited in reviews coordinated by institutions like Johns Hopkins University, Harvard School of Public Health, and Imperial College London. Training materials distributed by organizations such as World Bank and United Nations statistical divisions have also incorporated examples to illustrate assessment of exposure measurement and follow-up adequacy.
Empirical evaluations of the scale have been reported in methodological studies involving statisticians and epidemiologists from centers including University of Oxford, McMaster University, and Karolinska Institutet. Reliability assessments frequently compare inter-rater agreement using kappa statistics and contrast performance against other instruments developed by groups such as GRADE Working Group and ROBINS-I from the Cochrane Collaboration. Studies published in journals like Statistics in Medicine and Epidemiology have highlighted acceptable construct validity for certain domains while noting variability in rater-dependent judgments when applied across specialties represented at meetings like the Society for Epidemiologic Research.
Critiques arising in commentaries in BMJ and editorials in PLOS Medicine point to concerns about subjectivity in star allocation, limited granularity for complex confounding structures encountered in research sponsored by agencies such as National Institutes of Health and European Commission, and challenges when assessing novel designs emerging in research funded by foundations like Gates Foundation. Methodologists affiliated with Cochrane Collaboration and authors publishing in Journal of Clinical Epidemiology have argued the scale may inadequately capture bias domains addressed by tools like ROBINS-I, especially for time-varying exposures or selection biases emphasized in reports from Institute of Medicine.
Several research groups have proposed modified checklists or scoring rubrics tailored to specialty areas such as cardiovascular outcomes research endorsed by American College of Cardiology, oncology registries coordinated with National Cancer Institute, and environmental epidemiology studies linked to programs at Environmental Protection Agency. Adaptations have been incorporated into software and platforms used by systematic reviewers at institutions like Cochrane Collaboration and PROSPERO registries, and have inspired hybrid approaches combining elements of the scale with risk-of-bias frameworks published by organizations including GRADE Working Group and ROBINS-I developers.
Category:Research methods