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Objectives: To revise a sex and gender appraisal tool for systematic reviews (SGAT-SR) and apply it to Cochrane sepsis reviews. Study design and setting:The revision process was informed by existing literature on sex, gender, intersectionality, and feedback from an expert advisory board. We revised the items to consider additional factors associated with health inequities. We appraised sex and gender considerations using the SGAT-SR-2 and female Participation-to-Prevalence Ratio (PPR) in Cochrane sepsis reviews.Results: SGAT-SR-2 consists of 19 questions appraising the review's sections and use of the terms sex and gender. Among 71 SRs assessed, 50.7% included at least one tool item. The most frequent item was the number of participants by sex or gender at included study-level (24/71 reviews). Only four reviews provided disaggregated data for the full set of included trials, while two considered other equity-related factors. Reviews rarely appraised possible similarities and differences across sex and gender. In at least half of a subset of reviews, female participants were under-represented relative to their share of the sepsis population (PPR<0.8). Conclusion:The SGAT-SR-2 tool and the PPR can support the design and appraisal of systematic reviews to assess sex and gender considerations, address to whom evidence applies, and determine future research needs.

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