title: Level of evidence in plastic surgery research.
abstract: BACKGROUND
  There has been a recent shift toward evidence-based medicine in the medical and surgical literature. The objective of this study was to determine the level of evidence of published plastic surgery articles.
  
  
  METHODS
  A review of the following four major plastic surgery journal publications was performed to determine the level of evidence utilized in the published studies: Plastic and Reconstructive Surgery (PRS), Annals of Plastic Surgery (Annals), Journal of Plastic, Reconstructive, and Aesthetic Surgery (JPRAS), and American Journal of Aesthetic Surgery (Aesthetic) from January 1 to December 31, 2007.
  
  
  RESULTS
  Of the 1759 articles reviewed, 726 (41 percent) were included (animal studies, cadaver studies, basic science studies, review articles, instructional course lectures, and correspondence were excluded). The articles were ranked according to their level [level I (highest evidence, e.g., randomized-controlled trials) to level IV (lowest evidence, e.g., case reports)]. The average level of evidence in each journal was as follows: PRS, 3.05; Aesthetic, 3.11; JPRAS, 3.35; and Annals, 3.31. The evidence differed significantly between journals (p < 0.05), except when JPRAS was compared with the Aesthetic journal. Only 2.2 percent of articles were level I evidence.
  
  
  CONCLUSIONS
  The average level of evidence in four major plastic surgery journals was 3.2 (level III). In order for the plastic surgery profession to become a participant in higher-level evidence-based medicine, greater emphasis must be placed on prospective randomized blinded trials.
authors.affiliation: Montreal, Quebec, Canada From the Division of Plastic and Reconstructive Surgery, Department of Surgery, the Faculty of Medicine, and the Research Division, Department of Family Medicine, McGill University.
authors.forename: Hani
authors.initials: H
authors.lastname: Sinno
authors.forename: Omar Fouda
authors.initials: OF
authors.lastname: Neel
authors.forename: Justyn
authors.initials: J
authors.lastname: Lutfy
authors.forename: Gillian
authors.initials: G
authors.lastname: Bartlett
authors.forename: Mirko
authors.initials: M
authors.lastname: Gilardino
mesh_terms: D016021:Epidemiologic Studies; D019317:Evidence-Based Medicine / Q000145:classification / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D010506:Periodicals as Topic / Q000592:standards*; D016032:Randomized Controlled Trials as Topic; D012106:Research / Q000592:standards*; D013518:Surgery, Plastic