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Evidence-based practice in pediatric surgery.

W D Hardin1, S Stylianos, K P Lally

  • 1Department of Surgery, The University of Alabama School of Medicine, Birmingham, USA.

Journal of Pediatric Surgery
|June 8, 1999
PubMed
Summary
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Pediatric surgery literature lacks rigorous data for clinical practice. While prospective studies are increasing, multi-institutional trials are encouraged to develop evidence-based guidelines.

Area of Science:

  • Medical Research Methodology
  • Pediatric Surgery Evidence Base

Background:

  • Healthcare cost containment necessitates evidence-based practice.
  • Payors and regulators push for cost reduction through best practices.
  • Objective clinical data is crucial for informing healthcare policy.

Purpose of the Study:

  • To assess the current state of pediatric surgery literature.
  • To evaluate the literature's value in establishing best clinical practices.
  • To identify the proportion of rigorous scientific studies in pediatric surgery.

Main Methods:

  • Searched the Medline database for core pediatric surgery journals.
  • Defined criteria to identify prospective, randomized, controlled studies.
  • Categorized references into study types (case reports, series, trials, etc.).

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Main Results:

  • Over 9,000 references were identified; only 0.3% were prospective, randomized, controlled studies.
  • Prospective studies constituted 1.48%, while retrospective series dominated (59.9%).
  • The 1990s showed an increase in prospective and randomized controlled trials compared to previous decades.

Conclusions:

  • A significant lack of high-quality, rigorous data exists for pediatric surgical practice.
  • An increase in prospective studies in the 1990s indicates growing awareness.
  • Challenges like rare conditions and lack of equipoise hinder randomized trials; multi-institutional efforts are recommended.