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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.
Pediatric Surgery International
|November 18, 2023
Summary
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for common outpatient conditions lack robust evidence, leading to significant practice variations and reliance on outdated information.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- Early intervention practices are frequently based on weak, outdated studies, or "common wisdom" instead of robust evidence.
