Skip to main content

Evidence-based Pediatric Critical Care Medicine

  • Chapter
  • First Online:
  • 3451 Accesses

Abstract

Evidence-based medicine (EBM) strives to find the optimal course of action for a given clinical question by merging the best available scientific evidence with expert clinical judgment that incorporates a patient’s values and preferences. Although learning how to apply the concepts and principles of EBM is not intuitive, most clinicians become facile with modest effort. This chapter will describe the evolution of EBM from clinical and epidemiologic principles and research. We review the process of EBM in detail, including EBM core concepts related to articles on diagnosis, therapy, harm, and prognosis. We conclude by discussing the role of EBM in the PICU, emphasizing challenges and future directions.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312(7023):71–2.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Evidence-Based Medicine Working Group. Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA. 1992;268(17):2420–5.

    Article  Google Scholar 

  3. Sackett DL, Parkes J. Teaching critical appraisal: no quick fixes. CMAJ. 1998;158(2):203–4.

    CAS  PubMed Central  PubMed  Google Scholar 

  4. Oxman AD, Guyatt GH. Guidelines for reading literature reviews. CMAJ. 1988;138(8):697–703.

    CAS  PubMed Central  PubMed  Google Scholar 

  5. Pocock SJ. Clinical trials: a practical approach. Chichester: Wiley; 1983.

    Google Scholar 

  6. Lind J. A treatise of the scurvy. In three parts. Containing an inquiry into the nature, causes and cure, of that disease. Together with a critical and chronological view of what has been published on the subject. Edinburgh: A Kincaid and A Donaldson; 1753.

    Google Scholar 

  7. Louis PCA. Recherches sur les effets de la saignée dans quelques maladies inflammatoires et sur l’action de l’émétique et des vésicatoires dans la pneumonie. Paris: Librairie de l’Académie royale de médecine; 1835.

    Google Scholar 

  8. Lister J. Effects of the antiseptic system of treatment upon the salubrity of a surgical hospital. Lancet. 1870;1:40–2.

    Article  Google Scholar 

  9. Doll R. Controlled trials: the 1948 watershed. BMJ. 1998;317(7167):1217–20.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Medical Research Council Streptomycin in Tuberculosis Trials Committee. Streptomycin treatment for pulmonary tuberculosis. BMJ. 1948;ii:769–82.

    Google Scholar 

  11. Newman TB, Browner WS, Hulley SB. Enhancing causal inference in observational studies. In: Hulley SB, Cummings SR, editors. Designing clinical research. Philadelphia: Williams and Wilkins; 2005. p. 98–109.

    Google Scholar 

  12. Mahoney JF, Arnold RC, Sterner BL, Harris A, Zwally MR. Landmark article Sept 9, 1944: penicillin treatment of early syphilis: II. By J.F. Mahoney, R.C. Arnold, B.L. Sterner, A. Harris and M.R. Zwally. JAMA. 1984;251(15):2005–10.

    Article  CAS  PubMed  Google Scholar 

  13. Rosenberg DH, Arling PA. Landmark article Aug 12, 1944: penicillin in the treatment of meningitis. By D.H.Rosenberg and P.A.Arling. JAMA. 1984;251(14):1870–6.

    Article  CAS  PubMed  Google Scholar 

  14. Maio LL. Gastric freezing: an example of the evaluation and medicine therapy by randomized clinical trials. In: Bunker JP, Barnes BA, Mosteller F, editors. Costs, risks & benefits of surgery. New York: Oxford; 1977. p. 198–211.

    Google Scholar 

  15. Wangensteen OH, Peter ET, Nicoloff DM, Walder AI, Sosin H, Bernstein EF. Achieving “physiological gastrectomy” by gastric freezing. A preliminary report of an experimental and clinical study. JAMA. 1962;180:439–44.

    Article  CAS  PubMed  Google Scholar 

  16. Ruffin JM, Grizzle JE, Hightower NC, McHardy G, Shull H, Kirsner JB. A co-operative double-blind evaluation of gastric “freezing” in the treatment of duodenal ulcer. N Engl J Med. 1969;281(1):16–9.

    Article  CAS  PubMed  Google Scholar 

  17. Francis T, Korns RF, Voight RB, Boisen M, Hemphill FM, Napier JA, et al. An evaluation of the 1954 poliomyelitis vaccine trials. Am J Public Health. 1955;45(5, Part 2):1–63.

    Google Scholar 

  18. Meier P. The biggest public health experiment ever: the 1954 field trial of the Salk poliomyelitis vaccine. In: Tanur JM, editor. Statistics: a guide to the unknown. San Francisco: Holden-Day; 1972. p. 2–13.

    Google Scholar 

  19. Sackett DL, Haynes RB, Tugwell P. Clinical epidemiology: a basic science for clinical medicine. Toronto: Little Brown & Company; 1985.

    Google Scholar 

  20. Oxman AD, Sackett DL, Guyatt GH. Users’ guides to the medical literature I. How to get started. The Evidence-Based Medicine Working Group. JAMA. 1993;270(17):2093–5.

    Article  CAS  PubMed  Google Scholar 

  21. Guyatt GH, Sackett DL, Cook DJ. Users’ guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA. 1993;270(21):2598–601.

    Article  CAS  PubMed  Google Scholar 

  22. Guyatt GH, Sackett DL, Cook DJ. Users’ guides to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? Evidence-Based Medicine Working Group. JAMA. 1994;271(1):59–63.

    Article  CAS  PubMed  Google Scholar 

  23. Jaeschke R, Guyatt GH, Sackett DL. Users’ guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA. 1994;271(9):703–7.

    Article  CAS  PubMed  Google Scholar 

  24. Jaeschke R, Guyatt G, Sackett DL. Users’ guides to the medical literature. III. How to use an article about a diagnostic test. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA. 1994;271(5):389–91.

    Article  CAS  PubMed  Google Scholar 

  25. Laupacis A, Wells G, Richardson WS, Tugwell P. Users’ guides to the medical literature V. How to use an article about prognosis. Evidence-Based Medicine Working Group. JAMA. 1994;272(3):234–7.

    Article  CAS  PubMed  Google Scholar 

  26. Levine M, Walter S, Lee H, Haines T, Holbrook A, Moyer V. Users’ guides to the medical literature IV. How to use an article about harm. Evidence-Based Medicine Working Group. JAMA. 1994;271(20):1615–9.

    Article  CAS  PubMed  Google Scholar 

  27. Cook DJ, Sibbald WJ, Vincent JL, Cerra FB. Evidence based critical care medicine; what is it and what can it do for us? Evidence Based Medicine in Critical Care Group. Crit Care Med. 1996;24(2):334–7.

    Article  CAS  PubMed  Google Scholar 

  28. Guyatt G, Rennie D, Meade MO, Cook DJ. Users’ Guides to the Medical Literature: a manual for evidence-based clinical practice. 2nd ed. New York: McGraw Hill; 2008.

    Google Scholar 

  29. Sackett DL. Evidence-based medicine. Semin Perinatol. 1997;21(1):3–5.

    Article  CAS  PubMed  Google Scholar 

  30. Doig GS, Simpson F. Efficient literature searching: a core skill for the practice of evidence-based medicine. Intensive Care Med. 2003;29(12):2119–27.

    Article  PubMed  Google Scholar 

  31. Haynes RB, McKibbon KA, Walker CJ, Mousseau J, Baker LM, Fitzgerald D, et al. Computer searching of the medical literature. An evaluation of MEDLINE searching systems. Ann Intern Med. 1985;103(5):812–6.

    Article  CAS  PubMed  Google Scholar 

  32. Haynes RB, Wilczynski N, McKIBBON KA, Walker CJ, Sinclair JC. Developing optimal search strategies for detecting clinically sound studies in MEDLINE. J Am Med Inform Assoc. 1994;1(6):447–58.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Haynes RB, McKibbon KA, Wilczynski NL, Walter SD, Werre SR. Optimal search strategies for retrieving scientifically strong studies of treatment from Medline: analytical survey. BMJ. 2005;330(7501):1179.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Haynes RB, Wilczynski N. Finding the gold in MEDLINE: clinical queries. ACP J Club. 2005;142(1):A8–9.

    Google Scholar 

  35. Cook DJ, Meade MO, Fink MP. How to keep up with the critical care literature and avoid being buried alive. Crit Care Med. 1996;24(10):1757–68.

    Article  CAS  PubMed  Google Scholar 

  36. Duffett M, Choong K, Hartling L, Menon K, Thabane L, Cook DJ. Randomized controlled trials in pediatric critical care: a scoping review. Critical Care. 2013;17:R256.

    Article  PubMed  Google Scholar 

  37. Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents – Second Edition. Pediatr Crit Care Med. 2012;13(Suppl):S1–82.

    PubMed  Google Scholar 

  38. Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton  S, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents – Second Edition. Chapter 8. Hyperosmolar therapy. Pediatr Crit Care Med. 2012;13(Suppl):S36–41.

    Google Scholar 

  39. Atkins D, Briss PA, Eccles M, Flottorp S, Guyatt GH, Harbour RT, et al. Systems for grading the quality of evidence and the strength of recommendations II: pilot study of a new system. BMC Health Serv Res. 2005;5(1):25.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Guyatt G, Jaeschke R, Heddle N, Cook D, Shannon H, Walter S. Basic statistics for clinicians: 2. Interpreting study results: confidence intervals. CMAJ. 1995;152(2):169–73.

    CAS  PubMed Central  PubMed  Google Scholar 

  41. Dans AL, Dans LF, Guyatt GH, Richardson S. Users’ guides to the medical literature: XIV How to decide on the applicability of clinical trial results to your patient. Evidence-Based Medicine Working Group. JAMA. 1998;279(7):545–9.

    Article  CAS  PubMed  Google Scholar 

  42. Guyatt GH, Haynes RB, Jaeschke RZ, Cook DJ, Green L, Naylor CD, et al. Users’ Guides to the Medical Literature: XXV Evidence-based medicine: principles for applying the Users’ Guides to patient care. Evidence-Based Medicine Working Group. JAMA. 2000;284(10):1290–6.

    Article  CAS  PubMed  Google Scholar 

  43. Randolph AG, Meert KL, O’Neil ME, Hanson JH, Luckett PM, Arnold JH, et al. The feasibility of conducting clinical trials in infants and children with acute respiratory failure. Am J Respir Crit Care Med. 2003;167(10):1334–40.

    Article  PubMed  Google Scholar 

  44. Santschi M, Jouvet P, Leclerc F, Gauvin F, Newth CJ, Carroll CL, et al. Acute lung injury in children: therapeutic practice and feasibility of international clinical trials. Pediatr Crit Care Med. 2010;11(6):681–9.

    Article  PubMed  Google Scholar 

  45. Randolph AG, Wypij D, Venkataraman ST, Hanson JH, Gedeit RG, Meert KL, et al. Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: a randomized controlled trial. JAMA. 2002;288(20):2561–8.

    Article  PubMed  Google Scholar 

  46. Willson DF, Thomas NJ, Markovitz BP, Bauman LA, DiCarlo JV, Pon S, et al. Effect of exogenous surfactant (calfactant) in pediatric acute lung injury: a randomized controlled trial. JAMA. 2005;293(4):470–6.

    Article  CAS  PubMed  Google Scholar 

  47. Glasziou P, Haynes B. The paths from research to improved health outcomes. ACP J Club. 2005;142(2):A8–10.

    PubMed  Google Scholar 

  48. Cook DJ, Wall RJ, Foy R, Akl EA, Guyatt G, Schunemann H, et al. Changing behavior to apply best evidence in practice. In: Guyatt G, Rennie D, Meade MO, Cook DJ, editors. Users’ Guides to the medical literature: a manual for evidence-based clinical practice. 2nd ed. New York: McGraw Hill; 2008. p. 721–42.

    Google Scholar 

  49. Haynes RB. Of studies, syntheses, synopses, summaries, and systems: the “5S” evolution of information services for evidence-based healthcare decisions. Evid Based Med. 2006;11(6):162–4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Adrienne G. Randolph MD, MSc .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Boyer, D.L., Randolph, A.G. (2014). Evidence-based Pediatric Critical Care Medicine. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6362-6_16

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-6362-6_16

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6361-9

  • Online ISBN: 978-1-4471-6362-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics