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A reader's guide to the evaluation of causation.
  1. T. Podrebarac,
  2. P. Tugwell,
  3. P. C. Hébert
  1. Department of Medicine, University of Ottawa, Ontario, Canada.


    In this article, we review the criteria used to establish a causal association. A literature search strategy will be outlined. We present a clinical scenario that was formulated to examine the evidence for nonsteroidal anti-inflammatory drugs as a possible cause of gastrointestinal ulceration and bleeding. Several of the studies identified in the literature search were critically appraised and the criteria needed to confirm a causal link were then applied. These guidelines may be employed to not only demonstrate the aetiology of a disease but have wider applicability in terms of determining whether a medication may be causing certain adverse events.

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