CLISTA CLANTON, MSLS, AHIPJANUARY 15, 2009

EBM Resources for Pediatrics

Evidence-based Medicine

"Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannized by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients.“

-David L. SackettProfessor Emeritus, Clinical Epidemiology & Biostatistics McMaster University

Haynes, RB. ACPJC Nov/Dec 2006;145(3):A8-9

Start at top and work your way down

Information Resources

"Evidence-based medicine is ...a set of procedures, pre-appraised resources and information tools to assist practitioners to apply evidence from research in the care of individual patients".

-Kathleen Ann McKibbonAssociate Professor ,

Department of Clinical Epidemiology & Biostatistics

McMaster University

Computer system

Clinical Evidence, Dynamed, PIER, UpToDate

ACP Journal Club, PedsCCM Journal Club

Cochrane Library, PubMED Clinical Queries, guidelines

Original Studies

PICO

P=Patient or populationI=Intervention, Prognostic Factor or ExposureC=ComparisonO=Outcomes

Type of Question Suggested Best Type of Study

Therapy RCT > cohort > case control > case series

Diagnosis Prospective, blind comparison to gold standard

Etiology / Harm RCT > cohort > case control > case series

Prognosis Cohort study > case control > case series

Prevention RCT > cohort study > case control > case series

Clinical Exam Prospective, blind comparison to gold standard

Cost Economic analysis

Questions of therapy, etiology and prevention which can best be answered by RCT can also be answered by a meta-analysis or systematic review.

Evidence Pyramid

Case Series/Case Reports

Case Control Studies

Cohort Studies

Randomized Controlled Trial

Systematic Review

Meta-analysis

Animal Research

Question: In hospitalized infants with bronchiolitis, does the use of nebulized hypertonic saline help to reduce symptoms and LOS?

Type of question:

Type of study:

Therapy

RCT > cohort > case control > case series

In patient with

[Patient/ Problem]

does

[Intervention]

or

[Comparison, if any]

affect

[Outcome]

EBM Pediatric Resources on the Web

PedsCCM.org: Pediatric Critical Care Medicine Evidence-based Journal Reviewshttp://pedsccm.org/EBJournal_Club_intro.php

Cincinnatti Children’s Evidence-based Care Guildelineshttp://www.cincinnatichildrens.org/svc/alpha/h/health-policy/ev-based/default.htm

University of Michigan Evidence-based Pediatricshttp://www.med.umich.edu/pediatrics/ebm/

PhillyEBMhttp://www.phillyebm.com/drupal/

http://www.cebm.net/index.aspx?o=1216Prompts you for your clinical question, your search

strategy and key information about the study you foundProvides on-line critical appraisal guides for assessing

the validity and usefulness of the studyautomates the calculation of clinically useful measures

(and their 95% confidence intervals) Helps you formulate clinical "Bottom Lines" from what

you've readCreates 1-page summaries (CATs) that are easy to store,

print, retrieve, and share (as both text and HTML files);Helps you remember when to update each CAT you

createHelps you to teach others how to practice EBM