Conducting Retrospective Studies, Audits and Chart Reviews: A Practical Guide for Clinicians

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

In this short narrative paper, the author made an effort to provide educational materials regarding how to design and conduct a retrospective projects including audits and observational research advance the practice of emergency medicine. The author described certain issues regarding methodological challenges affecting data quality. The author then presented the context in the submitted paper as a “guideline”, which included an 11-step framework to guide the conduct of high-quality retrospective projects, minimizing bias and enhancing reproducibility for clinicians (perhaps specific for those in the field of emergency medicine). The author proposed a stepped approach mirrors the standard sections of a study protocol for users as a guiding reference (more practical, intuitive, and clear perhaps) and, as stated in the conclusion, the author believed this framework as a practical reference for clinicians' entry point to retrospective study design, methodologies, and strategies. Hopefully, clinicians in the emergency medicine field can learn from this “guideline” when a retrospective chart review is conducted on an evidence-based strategy.

Comment-1: It would be better to clarify whether this submitted paper is classified as a “guideline” paper? And Why?

Comment-2: In this submitted paper, the author described 11 steps regarding how to conduct a retrospective chart review related to, e.g., emergency medicine clinical research. It would be better for the author to emphasize or explain which parts of the knowledge are novel or with a knowledge gap. For example, in the Step 8, regarding the ethics review of a retrospective chart review protocol, are there new thoughts or practices different from what we are familiar with on a routine basis?

I understand the author put a lot of efforts in preparing the submitted materials and tried to present the paper as a useful/practical and educational reference (or guidance or guideline) for novice professionals/researchers in, e.g., emergency medicine field. I believe the author should clearly the novelty of all the context in the submitted paper and possibly present with the author’s unique experience or evidence.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Retrospective chart reviews (RCRs) use existing patient data from sources like medical records to address specific clinical or epidemiological questions. This approach is widely applied in fields such as epidemiology, medical education, and clinical research, offering valuable insights for future studies. However, the validity of RCRs can be compromised by vague research questions, poor sampling, and inconsistent data collection. Recognizing and addressing these methodological challenges is key to producing reliable results. When carefully conducted, RCRs transform routine documentation into structured evidence that advances healthcare knowledge.

This manuscript takes a close look at the common challenges researchers face when conducting retrospective chart reviews. It points out typical problems like vague research questions, poor data collection methods, and not checking reliability, all of which can weaken study results. The authors have given some examples and proven frameworks, making the paper a practical guide for anyone designing or assessing this type of research. They have demonstrated the workflow in 11 key steps including ethical and governance considerations and presented it systematically.

While there are similar articles in the literature, I feel this one stands out for its brevity and practical advice. However, I would have preferred the author to provide examples from published RCRs or audits and to clearly show how their steps relate to those published works. This approach would have given an edge to the present manuscript and would have been useful for early-career researchers. 

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

1. Data abstractors are still prone to fatigue, misinterpretation, or oversight, especially when dealing with large volumes of complex medical records. The process of abstracting data verbatim and precisely bounding it for citation, as done in this response, highlights the meticulous attention required, which can be challenging to maintain consistently in real-world research settings.
2. The guideline presents an 11-step framework as a practical guide. While it is designed to be accessible, its generalizability across all types of retrospective studies or healthcare settings may be thoroughly discussed particularly for non-clinical researchers, very large-scale national registries, or studies in highly specialized or rare disease areas are not explored.
3. The guideline advocated may address the practical challenges or potential limitations for researchers with constrained budgets or limited access to specialized support, which could hinder their ability to implement all recommended "high-quality" measures.
4. If the initial documentation is fundamentally flawed, incomplete, or biased (e.g., due to poor clinical practice or documentation habits), even the most rigorous data cleaning and analysis cannot fully compensate for these deep-seated issues.
5. The guideline briefly touches on ethical and governance considerations, noting that requirements can range from verbal confirmation to formal applications. However, the dynamic and evolving nature of these requirements, particularly across different jurisdictions, institutions, and over time, may be elaborated more.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Dear EIC

I noticed the author has made extensive revisions based on the suggestions on the submitted materials. Therefore, I have no further issues and be happy to make my recommendation: accept this paper to be published in the Journal.