Audit of therapeutic interventions in inpatient children using two scores: are they evidence-based in developing countries?
BACKGROUND
The evidence base of clinical interventions in paediatric hospitals of developing countries has not been formally assessed. We performed this study to determine the proportion of evidence-based therapeutic interventions in a paediatric referral hospital of a developing country


METHODS
The medical records of 167 patients admitted in one-month period were revised. Primary diagnosis and primary therapeutic interventions were determined for each patient. A systematic search was performed to assess the level of evidence for each intervention. Therapeutic interventions were classified using the Ellis score and the Oxford Centre for Evidence Based Medicine Levels of Evidence


RESULTS
Any dehydration due to diarrhoea (59 cases) and pneumonia (42 cases) were the most frequent diagnoses. Based on Ellis score, level I evidence supported the primary therapeutic intervention in 21%, level II in 73% and level III in 6% cases. Using the Oxford classification 16%, 8%, 1% and 75% therapeutic interventions corresponded to grades A, B, C, and D recommendations, respectively. Overall, according to Ellis score, 94% interventions were evidence based. However, out of the total, 75% interventions were based on expert opinion or basic sciences. Most children with mild to moderate dehydration (52 cases) were inappropriately treated with slow intravenous fluids, and most children with non-complicated community acquired pneumonia (42 cases) received intravenous antibiotics


CONCLUSIONS
Most interventions were inappropriate, despite the availability of effective therapy for several of them. Diarrhoeal dehydration and community acquired pneumonia were the most common diagnoses and were inappropriately managed. Existing effective interventions for dehydration and pneumonia need to be put into practice at referral hospitals of developing countries. For the remaining problems, there is the need to conduct appropriate clinical studies. Caution must be taken when assigning the level of evidence supporting therapeutic interventions, as commonly used classifications may be misleading.
Carreazo
Nilton Y
NY
Universidad Nacional Mayor de San Marcos and Instituto de Salud del Niño, Lima, LI 05, Peru. yhuro@hotmail.com <yhuro@hotmail.com>
Bada
Carlos A
CA
Chalco
Juan P
JP
Huicho
Luis
L
D002648:Child; D002673:Child, Hospitalized; D017714:Community-Acquired Infections / Q000628:therapy; D003681:Dehydration / Q000209:etiology / Q000628:therapy; D003906:Developing Countries; D003967:Diarrhea / Q000150:complications; D019317:Evidence-Based Medicine / Q000145:classification*; D006776:Hospitals, Pediatric / Q000592:standards*; D006785:Hospitals, University / Q000592:standards*; D006801:Humans; D008485:Medical Audit / Q000379:methods*; D010568:Peru; D011014:Pneumonia / Q000628:therapy; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation