Evidence-based surgery: interventions in a regional paediatric surgical unit.
OBJECTIVE
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.


METHODS
Prospective review of paediatric general surgical inpatients.


METHODS
A regional paediatric surgical unit.


METHODS
All consecutive paediatric general surgical patients admitted in November, 1995.


METHODS
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.
Kenny
S E
SE
Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool.
Shankar
K R
KR
Rintala
R
R
Lamont
G L
GL
Lloyd
D A
DA
D019317:Evidence-Based Medicine; D013502:General Surgery; D006801:Humans; D010372:Pediatrics / Q000592:standards*; D011446:Prospective Studies