What study type is considered at the highest rung of the evidence-based pyramid? 

  The highest rung on the evidence-based pyramid is the meta-analysis tier. Meta-analysis is a group of systematic reviews of multiple studies to find and compare the absolute best evidence available for a specific condition, population, or intervention. There is a precise, systematic methodology to research, choose, review, and evaluate the studies to include them in the meta-analysis (Tracy, et al., 2023). It gains the top tier of the evidence-based pyramid because meta-analysis yields the strongest level of evidence after all these systematic reviews (Melnyk & Fineoout-Overholt, 2019). These specific meta-analysis studies then present a summary of the current best evidence available for the area of interest. The meta-analyses can then guide clinicians to make evidence-based decisions for the treatment of their patients.

References: 

Melnyk, B. M., Fineout-Overholt, E. (2019). Evidence-Based Practice in Nursing and Healthcare (4th ed.). Wolters Kluwer

Tracy, M. F., O’Grady, E. T., & Phillips, S. J. (2023). Hamric & Hanson’s Advanced Practice Nursing: An Integrative Approach (7th ed.). Amsterdam: Elsevier.