Is the practice of paediatric inpatient medicine evidence-based?
OBJECTIVE
To determine whether management provided to paediatric inpatients in general units was supported by high-level evidence.


METHODS
A retrospective review was carried out of all patients (n = 142) admitted during one calendar month to two general paediatric units in the USA and Australia. For each patient, the primary diagnosis and primary treatment were determined. A literature review was performed to determine whether the therapy used was evidence-based. The main outcome measure was the level of evidence supporting the primary intervention for the primary diagnosis of each patient.


RESULTS
Level I evidence (at least one randomized trial) supported the primary intervention used in 31% of paediatric admissions and level II evidence (convincing non-experimental evidence) supported the primary intervention in 44% of admissions. Primary interventions were not supported by evidence (level III) in only two patients. The remaining 24% of patients were admitted for observation or evaluation only, and received no primary medical or surgical intervention. Most patients whose interventions were supported by randomized trials were admitted with either asthma or appendicitis.


CONCLUSIONS
Most primary interventions (75%) in paediatric inpatients were supported by high-level published evidence (level I or II). A large number of patients were admitted for evaluation or observation only, and received no therapeutic intervention. Evidence to support this action is not available.
Moyer
V A
VA
Center for Clinical Research and Evidence Based Medicine, University of Texas-Houston Medical School, Houston, Texas 77030, USA. virginia.a.moyer@uth.tmc.edu
Gist
A K
AK
Elliott
E J
EJ
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019317:Evidence-Based Medicine; D006748:Hospital Departments / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009517:New South Wales; D010372:Pediatrics / Q000592:standards*; D011787:Quality of Health Care; D012189:Retrospective Studies; D013781:Texas