Aim-Controversy exists regarding the evidence base of medicine, Estimates r
ange from 20% to 80% in various specialties, but there have been no studies
in paediatrics. The aim of this study was to ascertain the evidence base f
or community paediatrics.
Methods-Twelve community paediatricians working in clinics and schools in Y
orkshire, Manchester, Teesside, and Cheshire carried out a prospective revi
ew of consecutive clinical contacts. Evidence for diagnostic processes, pre
scribing, referrals, counselling/advice, and child health promotion was fou
nd by searching electronic databases. This information was critically appra
ised and a consensus was obtained regarding quality and whether it supporte
d actions taken.
Results-Two hundred and forty seven consultations and 1149 clinical actions
were performed. Good evidence was found from a randomised controlled trial
or other appropriate study for 39.9% of the 629 actions studied; convincin
g non-experimental evidence for 7%; inconclusive evidence for 25.4%; eviden
ce of ineffectiveness for 0.2%; and no evidence for 27.5%. Prescribing and
child health promotion activities had the highest levels of quality evidenc
e, and counselling/advice had the lowest.
Conclusions-An encouraging amount of evidence was found to support much of
community paediatric practice. This study improved on previous research in
other specialties because actions other than medications and surgery were i
ncluded.