[Evidence-based medicine in orthopedics - a sensible or unnecessary addition to clinical routine? Part 1: the diagnostics tool].
OBJECTIVE
The methods of evidence based medicine (EBM) are recommended to solve problems in day-to-day routine. Aim of this article is to demonstrate the practicability of this procedure for the diagnostic module.


METHODS
Within a teaching session in our department 20 participants guided by an extern al EBM teacher validated the results of an article according to the EBM criteria concerning the module "diagnosis". We demonstrate what EBM can contribute to solve day-to-day clinical problems and discuss the six formal steps for the implementation of EBM into day-to-day practice. 1) To transform the clinical problem into an answerable 4-part question. 2) To answer this question based on your internal evidence. 3) To search for external evidence to answer this question. 4) To critically appraise the evidence found with respect to its validity, importance and applicability. 5) To integrate the appraised external evidence into your existing internal evidence in order to come to a new decision if the additional new external evidence is convincing. 6) To assess the benefit which was gained for the patient.


RESULTS
Statistical tests to evaluate the relevance and validity of the chosen article were performed. The following data were determined: sensitivity, specifity, pretest probability, posttest probability, likelihood ratio, positive predictive value, negative predictive value.


CONCLUSIONS
In conclusion we show that EBM can help to solve day-to-day clinical problems, because the structured analysis of concrete questions can lead to a validation of the literature.
Schräder
P
P
Orthopädische Universitätsklinik Mannheim, Germany. p.schraeder@mds-er.de
Scharf
H-P
HP
Günther
K-P
KP
Puhl
W
W
Porzsolt
F
F
D002983:Clinical Competence; D003657:Decision Making; D020000:Decision Support Systems, Clinical; D019317:Evidence-Based Medicine / Q000193:education / Q000379:methods*; D005858:Germany; D006801:Humans; D009140:Musculoskeletal Diseases / Q000175:diagnosis*; D019637:Orthopedic Procedures / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care / Q000379:methods*