title: What Is the Quality of the Evidence in the Craniomaxillofacial Surgery Literature?
abstract: OBJECTIVE
  Evidence-based practice is an important concept for surgeons. The purpose of this study was to assess the quality of evidence in the craniomaxillofacial surgery (CMS) literature.
  
  
  METHODS
  This was a retrospective cohort study of patient-oriented articles published in 9 journals. The primary predictor variable was the year of publication (September 2007 to August 2008 or September 2012 to August 2013). Secondary predictor variables were journal, impact factor, subject (eg, reconstruction, esthetic surgery), and funding. The outcome variable was the level of evidence (levels 1 to 4), evaluated using the Center for Evidence-Based Medicine criteria. Descriptive, bivariate, and regression statistics were computed.
  
  
  RESULTS
  The study sample included 2,824 articles. The mean weighted journal impact factor was 1.6 ± 0.6 (range, 0.7 to 2.9). Fifty-two percent of articles were published in the Journal of Craniofacial Surgery or the Journal of Oral and Maxillofacial Surgery. The most frequent subject area was craniomaxillofacial pathology (934 articles; 33.1%). Eight percent of studies were funded. There were 97 (3.4%) level 1, 562 (19.9%) level 2, 228 (8.1%) level 3, and 1,937 (68.6%) level 4 studies. In a multiple regression model, year of publication (odds ratio [OR] = 1.2; P = .05), impact factor (OR = 2.4; P < .001), category (OR = 1.4; P < .001), and funding (OR = 1.6; P < .001) were associated with higher-quality evidence.
  
  
  CONCLUSIONS
  The quality of evidence in the CMS literature is low. Higher levels of evidence are associated with more recent publications, journal impact factor, topic area, and funding.
authors: Resident, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD. Electronic address: ssusarl1@jhmi.edu.
authors: Srinivas M
authors: SM
authors: Susarla
authors: Resident, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors: Gerhard S
authors: GS
authors: Mundinger
authors: Resident, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors: Edward W
authors: EW
authors: Swanson
authors: Resident, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA.
authors: Lauren E
authors: LE
authors: Basile
authors: Associate Professor, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA.
authors: Richard J
authors: RJ
authors: Redett
authors: Professor, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA.
authors: Thomas B
authors: TB
authors: Dodson
mesh_terms: D055317:Evidence-Based Practice; D006801:Humans; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*; D013515:Surgery, Oral