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Deciding without data: clinical decision-making in pediatric orthopedic surgery
Karthik Nathan1, Maechi Uzosike1, Uriel Sanchez1
1Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards R105, Stanford, CA 94304-1426, USA.
Summary
Pediatric orthopedic surgeons often rely on experience rather than scientific studies for decision-making. This highlights a need for evidence-based guidelines to improve pediatric orthopedic care quality and patient safety.
Area of Science:
- Orthopedic Surgery
- Evidence-Based Medicine
- Healthcare Quality Improvement
Background:
- Limited evidence guides decision-making in pediatric orthopedic surgery.
- Developing evidence-based treatment plans improves care quality and patient safety.
- Understanding decision rationale is key to improving pediatric orthopedic care.
Purpose of the Study:
- Investigate the decision-making rationale of pediatric orthopedic surgeons.
- Quantify the evidence supporting these decisions in an outpatient setting.
- Identify areas where evidence is lacking to inform guideline development.
Main Methods:
- Eight pediatric orthopedic surgeons' decisions were recorded in an outpatient clinic.
- Surgeons categorized the rationale for each decision using 12 predefined categories.
- 1150 total decisions were analyzed for rationale and evidence basis.
Main Results:
- The most frequent decisions involved follow-up scheduling and bracing.
- 'First principles' (27.0%) and 'Experience/anecdote' (22.0%) were the most common rationales.
- Only 17.8% of decisions were based on scientific studies, with surgical interventions showing higher evidence basis (34.6%).
Conclusions:
- Many pediatric orthopedic decisions are not primarily based on scientific studies.
- Evidence-based decision-making can enhance care quality and reduce waste.
- Developing clinical pathways and decision support tools is recommended for pediatric orthopedic surgery.
