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Department of Paediatric Surgery and Institute of Child
Health, Alder Hey Children's Hospital, Eaton Road, Liverpool L12 2AP
Correspondence to: Mr Kenny.
Accepted 18 September 1996
OBJECTIVES
To determine the proportion of
paediatric surgical interventions that are evidence-based and to
identify areas where randomised controlled trials (RCTs) or further
research are required.
DESIGNProspective review of paediatric general
surgical inpatients.
SETTINGA regional paediatric surgical unit.
SUBJECTSAll consecutive paediatric general
surgical patients admitted in November, 1995.
MAIN OUTCOME MEASURESEach patient on whom a
diagnosis had been made was allocated a primary diagnosis and primary
intervention (n=281). On the basis of expert knowledge, Plusnet
Medline, and ISI Science Citation database searches, each intervention
was categorised according to the level of supporting evidence: category
1, intervention based on RCT evidence; category 2, intervention with
convincing non-experimental evidence such that an RCT would be
unethical and unjustified; category 3, intervention without substantial supportive evidence.
RESULTSOf 281 patient interventions, 31 (11%)
were based on controlled trials and 185 (66%) on convincing
non-experimental evidence. Only 23% of interventions were category 3.
CONCLUSIONSIn common with other medical
specialties, the majority of paediatric surgical interventions are
based on sound evidence. However, only 11% of interventions are based
on RCT data, perhaps reflecting the nature of surgical practice.
Further RCTs or research is indicated in a proportion of category 3 interventions.
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