title: How current are leading evidence-based medical textbooks? An analytic survey of four online textbooks.
abstract: BACKGROUND
  The consistency of treatment recommendations of evidence-based medical textbooks with more recently published evidence has not been investigated to date. Inconsistencies could affect the quality of medical care.
  
  
  OBJECTIVE
  To determine the frequency with which topics in leading online evidence-based medical textbooks report treatment recommendations consistent with more recently published research evidence.
  
  
  METHODS
  Summarized treatment recommendations in 200 clinical topics (ie, disease states) covered in four evidence-based textbooks--UpToDate, Physicians' Information Education Resource (PIER), DynaMed, and Best Practice--were compared with articles identified in an evidence rating service (McMaster Premium Literature Service, PLUS) since the date of the most recent topic updates in each textbook. Textbook treatment recommendations were compared with article results to determine if the articles provided different, new conclusions. From these findings, the proportion of topics which potentially require updating in each textbook was calculated.
  
  
  RESULTS
  478 clinical topics were assessed for inclusion to find 200 topics that were addressed by all four textbooks. The proportion of topics for which there was 1 or more recently published articles found in PLUS with evidence that differed from the textbooks' treatment recommendations was 23% (95% CI 17-29%) for DynaMed, 52% (95% CI 45-59%) for UpToDate, 55% (95% CI 48-61%) for PIER, and 60% (95% CI 53-66%) for Best Practice (χ(2) (3)=65.3, P<.001). The time since the last update for each textbook averaged from 170 days (range 131-209) for DynaMed, to 488 days (range 423-554) for PIER (P<.001 across all textbooks).
  
  
  CONCLUSIONS
  In online evidence-based textbooks, the proportion of topics with potentially outdated treatment recommendations varies substantially.
authors.affiliation: Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jeffery
authors.forename: Tamara
authors.initials: T
authors.lastname: Navarro
authors.forename: Cynthia
authors.initials: C
authors.lastname: Lokker
authors.forename: R Brian
authors.initials: RB
authors.lastname: Haynes
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Wilczynski
authors.forename: George
authors.initials: G
authors.lastname: Farjou
mesh_terms: D003625:Data Collection; D004501:Education, Medical / Q000379:methods*; D019317:Evidence-Based Medicine