Evidence-based surgery: Interventions in a regional paediatric surgical unit

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. Design-Prospective review of paediatric general surgical inpatients. Setting-A regional paediatric surgical unit. Subjects-All consecutive paediatric general surgical patients admitted in November, 1995. Main outcome measures-Each 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. Results-Of 281 patient interventions, 31 (11%) were based on controlled trials and 185 (66%) on convincing nonexperimental evidence. Only 23% of interventions were category 3. Conclusions-In 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.