Applying evidence-based surgery in daily clinical routine: a feasibility study.
BACKGROUND
Although the word evidence-based medicine (EBM) has gained wide popularity, only a few studies have evaluated how EBM works in clinical practice.


METHODS
We have prospectively evaluated the feasibility of evidence-based trauma surgery. Orthopaedic trauma surgeons were asked to produce clinical questions related to the treatment of current patients. An informaticist searched the literature (Medline, Cochrane Library, practice guidelines and textbooks) and reported the findings on every following day. The study's main endpoints were the rate of questions for which relevant evidence (>level V) was available and the time necessary to find and critically appraise medical evidence.


RESULTS
In total, 44 EBM questions were formulated, mainly concerning treatment options. PubMed was searched for 39 questions, textbooks for 14, the Cochrane Library for 11, online guidelines for 9 and other sources were used for 4 questions. On average, 157 text items (three per questions) were identified as potentially relevant. Journal articles predominated (83%) over textbooks (10%). Sixty-eight percent of the questions (30 of 44) were answered, either on the basis level 1 (n=13 questions), level 2 (n=6), or level 4 evidence (n=14). Trying to answer a question required 53 min on average, split up between 39 min of database searches and 25 min of obtaining full text articles. In four cases, the evidence suggested a change in clinical management. The physicians were very appreciative of our project and found the provided evidence very helpful for their clinical decisions.


CONCLUSIONS
Time will be the main barrier against the introduction of clinical EBM. It is likely that clinicians reduce EBM to those situations where evidence is likely to be found. Although the impact of EBM on patient-care was limited, the concept of EBM was successfully implemented.
Krahn
Jan
J
Institute for Research in Operative Medicine, Faculty of Medicine, University of Witten/Herdecke, Ostmerheimer Strasse 200, Cologne, Germany.
Sauerland
Stefan
S
Rixen
Dieter
D
Gregor
Sven
S
Bouillon
Bertil
B
Neugebauer
Edmund A M
EA
D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003955:Diagnostic Tests, Routine; D019317:Evidence-Based Medicine / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000592:standards* / Q000639:trends; D019095:Point-of-Care Systems; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000639:trends; D011787:Quality of Health Care; D012307:Risk Factors; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires