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The evidence mismatch in pediatric surgical practice
Marina Broomfield1,2, Zena Agabani1,3, Elena Guadagno1
1Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada.
Insights
Pediatric surgical practices for common outpatient conditions lack robust evidence, leading to significant practice variations and reliance on outdated information. Many recommendations are not evidence-based, creating a mismatch with actual clinical practice.
Area of Science:
- Pediatric Surgery
- Evidence-Based Medicine
- Health Services Research
Background:
- Outpatient pediatric surgery frequently addresses conditions causing parental anxiety despite low morbidity.
- Existing evidence-based management recommendations may not align with current clinical practices.
Purpose of the Study:
- To investigate the evidence base for four common outpatient pediatric surgical conditions: dermoid cysts, epigastric hernias, hydroceles, and umbilical hernias.
- To identify the mismatch between evidence-based recommendations and actual practice patterns.
Main Methods:
- A rapid review was conducted following Cochrane Rapid Review Group guidelines.
- Data were extracted from 49 cohort studies published since 1990, encompassing 34,172 patients across 18 countries.
- A metric of evidence volume (patient/publication ratio) was generated and compared across diagnoses.
Main Results:
- The literature volume for these conditions is sparse, averaging less than one cohort study per condition per year.
- A significant evidence mismatch rate, ranging from 33% to 75%, was observed.
- Many current recommendations are not evidence-based, are sometimes conflicting, and often misrepresent clinical practice.
Conclusions:
- Published literature on common outpatient pediatric surgical conditions is limited, showing considerable practice variations.
- Justifications for surgical choices often rely on complication risks or patient preference, rather than strong evidence.
- Early intervention practices are frequently based on weak, outdated studies, or "common wisdom" instead of robust evidence.
Purpose:
Outpatient pediatric surgical practice often involves conditions of limited morbidity but significant parental concern. We explore existing evidence-based management recommendations and the mismatch with practice patterns for four common outpatient pediatric surgical conditions.
Methods:
Using the Cochrane Rapid Review Group recommendations and librarian oversight, we conducted a rapid review of four outpatient surgical conditions: dermoid cysts, epigastric hernias, hydroceles, and umbilical hernias. We extracted patient demographics, intervention details, outcome measures and evaluated justifications presented for chosen management options. A metric of evidence volume (patient/publication ratio) was generated and compared between diagnoses.
Results:
Out of 831 articles published since 1990, we identified 49 cohort studies (10-dermoid cyst, 6-epigastric hernia, 25-hydrocele, and 8-umbilical hernia). The 49 publications included 34,172 patients treated across 18 countries. The evidence volume for each outpatient condition demonstrates < 1 cohort/condition/year. The evidence mismatch rate varied between 33 and 75%; many existing recommendations are not evidence-based, sometimes conflicting and frequently misrepresentative of clinical practice.
Conclusions:
Published literature concerning common outpatient pediatric surgical conditions is sparse and demonstrates wide variations in practice. All individual practice choices were justified using either risk of complications or patient preference. Most early intervention practices were based on weak or outdated studies and "common wisdom" rather than genuine evidence.
Level Of Evidence:
III.
