EVIDENCE-BASED SURGERY - INTERVENTIONS IN A REGIONAL PEDIATRIC SURGICAL UNIT

Objectives-To determine the proportion of paediatric surgical interven tions that are evidence-based and to identify areas where randomised c ontrolled trials (RCTs) or further research are required. Design-Prosp ective review of paediatric general surgical inpatients. Setting-A reg ional paediatric surgical unit. Subjects-All consecutive paediatric ge neral surgical patients admitted in November, 1995. Main outcome measu res-Each patient on whom a diagnosis had been made was allocated a pri mary diagnosis and primary intervention (n=281). On the basis of exper t knowledge, Plusnet Medline, and ISI Science Citation database search es, each intervention was categorised according to the level of suppor ting evidence: category 1, intervention based on RCT evidence; categor y 2, intervention with convincing non-experimental evidence such that an RCT would be unethical and unjustified; category 3, intervention wi thout substantial supportive evidence. Results-Of 281 patient interven tions, 31 (11%) were based on controlled trials and 185 (66%) on convi ncing nonexperimental evidence. Only 23% of interventions were categor y 3. Conclusions-In common with other medical specialties, the majorit y of paediatric surgical interventions are based on sound evidence. Ho wever, only 11% of interventions are based on RCT data, perhaps reflec ting the nature of surgical practice. Further RCTs or research is indi cated in a proportion of category 3 interventions.