title: Evidence-based clinical management and utilization of new technology in European neurosurgery.
abstract: BACKGROUND
  Evidence-based medicine (EBM) has become one of the pillars of modern patient care. However, neurosurgery has always been an experience-based and technology-driven discipline, and it remains unknown to which extent European neurosurgeons follow high-level evidence-based recommendations.
  
  
  METHODS
  We conducted a Web-based survey with a 15-item questionnaire about evidence-based clinical management and utilization of new technology among European neurosurgeons. Two different sum scores were calculated from the questions concerning clinical practice; evidence-based treatment score and new technology score. A high evidence-based treatment score means that more clinical conditions (i.e., study questions) were managed in compliance with the available highest levels of evidence from published clinical trials. A high new technology score reflects the use of a high number of modern tools in neurosurgical practice.
  
  
  RESULTS
  A total of 239 neurosurgeons from 30 different European countries answered the questionnaire. There were large variations among European neurosurgeons in providing evidence-based care and in utilization of various modern tools. There were significant regional differences in evidence-based treatment scores and modern technology scores with higher scores in northern and western Europe. High-volume institutions were not associated with better evidence-based treatment scores, but had significantly higher new technology scores. There were significantly higher new technology scores at university hospitals and a trend towards higher evidence-based treatment scores compared to other hospitals.
  
  
  CONCLUSIONS
  Clinical management in neurosurgery does not always comply with the best available evidence and there are large regional differences in clinical management and in utilization of various modern tools. The position of evidence-based medicine in European neurosurgery seems weak and this may be a threat to the quality of care.
authors: Department of Neurosurgery, St. Olavs University Hospital, Postboks 3250 Sluppen, 7006, Trondheim, Norway. clemens.weber@gmail.com
authors: Clemens
authors: C
authors: Weber
authors: Asgeir S
authors: AS
authors: Jakola
authors: Sasha
authors: S
authors: Gulati
authors: Oystein P
authors: OP
authors: Nygaard
authors: Ole
authors: O
authors: Solheim
mesh_terms: D005060:Europe; D019317:Evidence-Based Medicine; D019538:Health Care Surveys; D006801:Humans; D009493:Neurosurgery / Q000379:methods*; D019635:Neurosurgical Procedures; D011787:Quality of Health Care; D011795:Surveys and Questionnaires