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Evidence-based surgery: interventions in a regional paediatric surgical unit
S E Kenny1, K R Shankar, R Rintala
1Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool.
Insights
Most paediatric surgical procedures have evidence backing them, but only 11% use randomized controlled trials (RCTs). Further research is needed for some interventions lacking substantial evidence.
Area of Science:
- Pediatric Surgery
- Evidence-Based Medicine
Background:
- Assessing the evidence base for pediatric surgical interventions is crucial for improving patient outcomes.
- Understanding the proportion of procedures supported by robust scientific evidence guides future research priorities.
Purpose of the Study:
- To quantify the evidence-based proportion of pediatric surgical interventions.
- To identify areas within pediatric surgery requiring further research, particularly randomized controlled trials (RCTs).
Main Methods:
- A prospective review of 281 consecutive pediatric general surgical inpatients was conducted.
- Interventions were categorized based on the level of supporting evidence: RCTs, convincing non-experimental evidence, or lacking substantial evidence.
Main Results:
- 11% of pediatric surgical interventions were supported by randomized controlled trial (RCT) evidence.
- 66% of interventions had convincing non-experimental evidence, while 23% lacked substantial supportive evidence.
Conclusions:
- The majority of pediatric surgical interventions are supported by sound evidence, aligning with other medical fields.
- The low proportion of RCT-based interventions highlights the unique challenges in surgical research.
- Further research, including RCTs, is recommended for interventions categorized as lacking substantial evidence.
Objectives:
To determine the proportion of paediatric surgical interventions that are evidence-based and to identify areas where randomised controlled trials (RCTs) or further research are required.
Design:
Prospective review of paediatric general surgical inpatients.
Setting:
A regional paediatric surgical unit.
Subjects:
All consecutive paediatric general surgical patients admitted in November, 1995.
Main Outcome Measures:
Each patient on whom a diagnosis had been made was allocated a primary diagnosis and primary intervention (n = 281). On the basis of expert knowledge, Plusnet Medline, and ISI Science Citation database searches, each intervention was categorised according to the level of supporting evidence: category 1, intervention based on RCT evidence; category 2, intervention with convincing non-experimental evidence such that an RCT would be unethical and unjustified; category 3, intervention without substantial supportive evidence.
Results:
Of 281 patient interventions, 31 (11%) were based on controlled trials and 185 (66%) on convincing non-experimental evidence. Only 23% of interventions were category 3.
Conclusions:
In common with other medical specialties, the majority of paediatric surgical interventions are based on sound evidence. However, only 11% of interventions are based on RCT data, perhaps reflecting the nature of surgical practice. Further RCTs or research is indicated in a proportion of category 3 interventions.