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Treatment in the pediatric emergency department is evidence based: a retrospective analysis
Kellie L Waters1, Natasha Wiebe, Kristie Cramer
1Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. kelliewaters@cha.ab.ca
Insights
Most pediatric emergency department treatments are evidence-based, primarily using pediatric studies. A significant number of patients in the pediatric emergency department receive no intervention.
Area of Science:
- Pediatric Emergency Medicine
- Evidence-Based Practice
- Clinical Decision-Making
Background:
- Assessing the evidence base for pediatric emergency department (PED) treatment decisions.
- Determining the proportion of evidence originating from pediatric-specific studies.
Purpose of the Study:
- To quantify the evidence supporting treatment decisions in a pediatric emergency department.
- To ascertain the percentage of evidence for PED treatments derived from pediatric research.
Main Methods:
- Retrospective chart review of randomly selected patients in a PED (2002).
- Identification of primary diagnosis and intervention for each patient.
- Literature search for randomized control trials (RCTs) or systematic reviews to classify evidence levels (Level I, II, III).
Main Results:
- 80.4% of 168 assessed interventions were evidence-based (Level I).
- 83.7% of evidence-based interventions were supported by studies predominantly involving pediatric patients.
- 35.9% of patients received no primary intervention.
Conclusions:
- A substantial proportion of pediatric emergency department treatment decisions are evidence-based.
- Most evidence supporting PED treatments comes from pediatric patient studies.
- A significant number of pediatric emergency department patients do not receive an intervention.
Background:
Our goal was to quantify the evidence that is available to the physicians of a pediatric emergency department (PED) in making treatment decisions. Further, we wished to ascertain what percentage of evidence for treatment provided in the PED comes from pediatric studies.
Methods:
We conducted a retrospective chart review of randomly selected patients seen in the PED between January 1 and December 31, 2002. The principal investigator identified a primary diagnosis and primary intervention for each chart. A thorough literature search was then undertaken with respect to the primary intervention. If a randomized control trial (RCT) or a systematic review was found, the intervention was classified as level I evidence. If no RCT was found, the intervention was assessed by an expert committee who determined its appropriateness based on face validity (RCTs were unanimously judged to be both unnecessary and, if a placebo would have been involved, unethical). These interventions were classified as level II evidence. Interventions that did not fall into either above category were classified as level III evidence.
Results:
Two hundred and sixty-two patient charts were reviewed. Of these, 35.9% did not receive a primary intervention. Of the 168 interventions assessed, 80.4% were evidence-based (level I), 7.1% had face validity (level II) and 12.5% had no supporting evidence (level III). Of the evidence-based interventions, 83.7% were supported by studies with mostly pediatric patients.
Conclusion:
Our study demonstrates that a substantial proportion of PED treatment decisions are evidence-based, with most based on studies in pediatric patients. Also, a large number of patients seen in the PED receive no intervention.
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