Treatment in the pediatric emergency department is evidence based: a retrospective analysis

• Main Authors: Hartling Lisa, Cramer Kristie, Wiebe Natasha, Waters Kellie L, Klassen Terry P
• Format: Article
• Language: English
• Published: BMC 2006-10-01
• Series: BMC Pediatrics
• Online Access: http://www.biomedcentral.com/1471-2431/6/26

<p>Abstract</p> <p>Background</p> <p>Our goal was to quantify the evidence that is available to the physicians of a pediatric emergency department (PED) in making treatment decisions. Further, we wished to ascertain what percentage of evidence for treatment provided in the PED comes from pediatric studies.</p> <p>Methods</p> <p>We conducted a retrospective chart review of randomly selected patients seen in the PED between January 1 and December 31, 2002. The principal investigator identified a primary diagnosis and primary intervention for each chart. A thorough literature search was then undertaken with respect to the primary intervention. If a randomized control trial (RCT) or a systematic review was found, the intervention was classified as level I evidence. If no RCT was found, the intervention was assessed by an expert committee who determined its appropriateness based on face validity (RCTs were unanimously judged to be both unnecessary and, if a placebo would have been involved, unethical). These interventions were classified as level II evidence. Interventions that did not fall into either above category were classified as level III evidence.</p> <p>Results</p> <p>Two hundred and sixty-two patient charts were reviewed. Of these, 35.9% did not receive a primary intervention. Of the 168 interventions assessed, 80.4% were evidence-based (level I), 7.1% had face validity (level II) and 12.5% had no supporting evidence (level III). Of the evidence-based interventions, 83.7% were supported by studies with mostly pediatric patients.</p> <p>Conclusion</p> <p>Our study demonstrates that a substantial proportion of PED treatment decisions are evidence-based, with most based on studies in pediatric patients. Also, a large number of patients seen in the PED receive no intervention.</p>