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Audit of therapeutic interventions in inpatient children using two scores: are they evidence-based in developing
Nilton Y Carreazo1, Carlos A Bada, Juan P Chalco
1Universidad Nacional Mayor de San Marcos and Instituto de Salud del Niño, Lima, LI 05, Peru. yhuro@hotmail.com <yhuro@hotmail.com>
Insights
Most paediatric interventions in developing countries are not evidence-based, leading to inappropriate treatment for common conditions like dehydration and pneumonia. Implementing existing guidelines is crucial for improving care.
Area of Science:
- Paediatric Medicine
- Health Services Research
- Evidence-Based Practice
Background:
- The evidence supporting clinical interventions in paediatric hospitals in developing nations remains unassessed.
- This study aimed to evaluate the proportion of evidence-based therapeutic interventions in a developing country's paediatric referral hospital.
Purpose of the Study:
- To determine the proportion of evidence-based therapeutic interventions in a paediatric referral hospital in a developing country.
- To identify common diagnoses and assess the appropriateness of their management.
Main Methods:
- Retrospective review of 167 patient records from a one-month period.
- Systematic search to determine the level of evidence for each primary therapeutic intervention.
- Classification of interventions using the Ellis score and Oxford Centre for Evidence-Based Medicine Levels of Evidence.
Main Results:
- Diarrhoeal dehydration (59 cases) and pneumonia (42 cases) were the most frequent diagnoses.
- While 94% of interventions were deemed evidence-based by the Ellis score, 75% relied on expert opinion or basic science.
- Inappropriate management was observed, including slow intravenous fluids for dehydration and intravenous antibiotics for uncomplicated pneumonia.
Conclusions:
- A significant proportion of paediatric interventions in this setting were inappropriate, despite available effective therapies.
- Diarrhoeal dehydration and pneumonia were commonly mismanaged, highlighting a gap between evidence and practice.
- There is a need to implement existing effective interventions and conduct further clinical studies, with caution advised when applying evidence-based medicine classifications.
Background:
The evidence base of clinical interventions in paediatric hospitals of developing countries has not been formally assessed. We performed this study to determine the proportion of evidence-based therapeutic interventions in a paediatric referral hospital of a developing country
Methods:
The medical records of 167 patients admitted in one-month period were revised. Primary diagnosis and primary therapeutic interventions were determined for each patient. A systematic search was performed to assess the level of evidence for each intervention. Therapeutic interventions were classified using the Ellis score and the Oxford Centre for Evidence Based Medicine Levels of Evidence
Results:
Any dehydration due to diarrhoea (59 cases) and pneumonia (42 cases) were the most frequent diagnoses. Based on Ellis score, level I evidence supported the primary therapeutic intervention in 21%, level II in 73% and level III in 6% cases. Using the Oxford classification 16%, 8%, 1% and 75% therapeutic interventions corresponded to grades A, B, C, and D recommendations, respectively. Overall, according to Ellis score, 94% interventions were evidence based. However, out of the total, 75% interventions were based on expert opinion or basic sciences. Most children with mild to moderate dehydration (52 cases) were inappropriately treated with slow intravenous fluids, and most children with non-complicated community acquired pneumonia (42 cases) received intravenous antibiotics
Conclusions:
Most interventions were inappropriate, despite the availability of effective therapy for several of them. Diarrhoeal dehydration and community acquired pneumonia were the most common diagnoses and were inappropriately managed. Existing effective interventions for dehydration and pneumonia need to be put into practice at referral hospitals of developing countries. For the remaining problems, there is the need to conduct appropriate clinical studies. Caution must be taken when assigning the level of evidence supporting therapeutic interventions, as commonly used classifications may be misleading.
