Outcomes and Evidence-Based Practice Committee

Introduction

The Outcomes and Evidence-based Practice Committee (OEBPC) will facilitate the efforts of APSA members either individually or as an organization to develop clinical outcomes data and evidence-based recommendations relevant to the practice of pediatric surgery. At the request of the APSA membership and/or the Board of Governors of APSA, the OEBPC will serve to identify important areas of clinical guidelines and research in order to formulate and disseminate appropriate recommendations to assist APSA members in their practices. The OEBPC will be a central resource for APSA members to help promote clinical and outcomes research in pediatric surgery. The OEBPC will work collaboratively with other existing APSA committees to identify and address educational and/or programmatic needs and opportunities for the APSA membership as they relate to clinical outcomes. At the request of the APSA membership and/or the BOG of APSA, the OEBPC will serve to identify important areas of clinical guidelines and research in order to formulate and disseminate appropriate recommendations to assist APSA members in their practices. The OEBPC will be a central resource for APSA members to help promote clinical and outcomes research in pediatric surgery. The OEBPC will work collaboratively with other existing APSA committees to identify and address educational and/or programmatic needs and opportunities for the APSA membership as they relate to clinical outcomes.

To see the membership of the committee please visit the Outcomes and Evidence-based Practice Committee page on apsapedsurg.org.

Outcomes and Evidence-based Practice articles of interest

Outcomes Research

The Outcomes and Evidence-based Practice Committee aims to facilitate the efforts of APSA members, either individually or as an organization, to develop clinical outcomes data and evidence-based recommendations relevant to the practice of pediatric surgery. Their mission is to support the Outcomes and Evidence-based Practice activities of the membership and to be a forum to promote collaboration and provide national leadership on these issues for the practicing pediatric surgeon.

What is outcomes research?

Outcomes research seeks to understand the end results of particular health care practices and interventions. For clinicians and patients, outcomes research provides evidence about benefits, risks and results of treatments so they can make more informed decisions [1]. Outcomes research is aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome, improved health, lowered morbidity or mortality and improvement of abnormal states [2]. Classically, the key feature of outcomes research was the emphasis on effectiveness (i.e. the effect of an intervention as applied to broad populations in real practice). The umbrella term “outcomes research” now loosely covers a broad range of study questions (e.g. quality of care, access, decision making, prediction rules and effectiveness), methods (e.g. analysis of administrative databases and decision analysis) and end points (e.g. health-related quality of life and costs) [3].

The terms outcomes research and health services research are increasingly synonymous. Those who make a distinction between these terms regard outcomes research as measuring and addressing clinical issues and health services research as responding to policy questions [3]. Outcomes and health services research seek to identify the most effective and most efficient interventions, treatments and services [4]. Health services research is usually concerned with relationships between need, demand, supply, use and outcome of health services [2].

The NIH defines a clinical trial as a prospective biomedical or behavioral research study of human subjects that is designed to answer specific questions about biomedical or behavioral interventions (e.g. drugs, treatments, devices or new ways of using known drugs, treatments or devices) [5]. The key feature of a clinical trial is to measure the effect of the intervention under controlled circumstances.

Systematic Reviews

Systematic reviews aid, but do not replace, sound clinical reasoning.

The committee generates a series of systematic reviews on topics in pediatric general surgery. Timely, useful evidence from the biomedical literature should be an integral component of clinical decision making [6]. A properly conducted systematic review faithfully summarizes the evidence from all relevant studies on the topic of interest and it does so concisely and transparently. Systematic reviews are summaries of the medical literature that are performed using a thorough literature search. Each review addresses a clearly formulated question.

When the results of primary studies are summarized but not statistically combined, the review may be called a qualitative systematic review.

A quantitative systematic review, or meta-analysis, is a systematic review that uses statistical methods to combine the results of two or more studies.

Anesthesia and neurodevelopment

Appendicitis

  • Time to appendectomy for acute appendicitis: A systematic review, Cameron et al [7]
  • Antibiotics for apppendicitis
    • Antibiotics and appendicitis in the pediatric population: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee Systematic Review, Lee et al [8]

Congenital diaphragmatic hernia

  • Management of congenital diaphragmatic hernia: A systematic review from the APSA outcomes and evidence based practice committee, Puligandla et al [9]

Congenital pulmonary airway malformations

Cryptorchidism

Central venous catheter infection

Empyema

  • Empyema
  • The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee, Islam et al [11]

Enteral access

  • video link APSA 2020 virtual meeting systematic review on Enteral Access

Gastroesophageal reflux disease

Gastroschisis and omphalocele

Intussusception

Long gap esophageal atresia

  • Management of long gap esophageal atresia: A systematic review and evidence-based guidelines from the APSA Outcomes and Evidence Based Practice Committe, Baird et al [13]

Long segment Hirshsprung disease

Necrotizing enterocolitis

  • Necrotizing Enterocolitis
  • Treatment of necrotizing enterocolitis: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review, Downard et al [14]

Ovarian masses

  • Ovarian masses in the child and adolescent: An American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee systematic review, Renaud et al [15]

Ovarian torsion

  • Ovarian torsion in pediatric and adolescent patients: A systematic review Dasgupta et al [16]

Pilonidal disease

Parenteral nutrition-associated cholestasis

Solid Organ injuries

  • Non-operative Management of Solid Organ Injuries in Children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review, Gates et al [19]

Resources

Evidence-based medicine in pediatric surgery

The 97th Clinical Congress of the American College of Surgeons held in San Francisco, CA in October, 2011 included a session entitled, "Evidence-Based Medicine in Pediatric Surgery: Don’t Confuse Me with Facts, My Mind is Made Up." The session was moderated by Marjorie Arca and Daniel Ostlie. View the four presentations below which are made available at the request of the APSA membership. (The slides are the property of Drs. Moss, St. Peter, Abdullah and Oldham. They may not be altered or reproduced in any form.)

References

  1. http://www.ahrq.gov/clinic/outfact.htm




  2. http://www.nlm.nih.gov/mesh


  3. Lee SJ, Earle CC, Weeks JC. Outcomes research in oncology: history, conceptual framework, and trends in the literature. J Natl Cancer Inst. 2000;92(3):195-204.  [PMID:10655436]
  4. http://www.nichd.nih.gov/health/clinicalresearch/





  5. http://grants.nih.gov/grants/policy/hs/glossary.htm

  6. Cook DJ, Mulrow CD, Haynes RB. Systematic reviews: synthesis of best evidence for clinical decisions. Ann Intern Med. 1997;126(5):376-80.  [PMID:9054282]
  7. Cameron DB, Williams R, Geng Y, et al. Time to appendectomy for acute appendicitis: A systematic review. J Pediatr Surg. 2018;53(3):396-405.  [PMID:29241958]
  8. Lee SL, Islam S, Cassidy LD, et al. Antibiotics and appendicitis in the pediatric population: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg. 2010;45(11):2181-5.  [PMID:21034941]
  9. Puligandla PS, Grabowski J, Austin M, et al. Management of congenital diaphragmatic hernia: A systematic review from the APSA outcomes and evidence based practice committee. J Pediatr Surg. 2015;50(11):1958-70.  [PMID:26463502]
  10. Downard CD, Calkins CM, Williams RF, et al. Treatment of congenital pulmonary airway malformations: a systematic review from the APSA outcomes and evidence based practice committee. Pediatr Surg Int. 2017;33(9):939-953.  [PMID:28589256]
  11. Islam S, Calkins CM, Goldin AB, et al. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Pediatr Surg. 2012;47(11):2101-10.  [PMID:23164006]
  12. Jancelewicz T, Lopez ME, Downard CD, et al. Surgical management of gastroesophageal reflux disease (GERD) in children: A systematic review. J Pediatr Surg. 2017;52(8):1228-1238.  [PMID:27823773]
  13. Baird R, Lal DR, Ricca RL, et al. Management of long gap esophageal atresia: A systematic review and evidence-based guidelines from the APSA Outcomes and Evidence Based Practice Committee. J Pediatr Surg. 2019;54(4):675-687.  [PMID:30853248]
  14. Downard CD, Renaud E, St Peter SD, et al. Treatment of necrotizing enterocolitis: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg. 2012;47(11):2111-22.  [PMID:23164007]
  15. Renaud EJ, Sømme S, Islam S, et al. Ovarian masses in the child and adolescent: An American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee systematic review. J Pediatr Surg. 2019;54(3):369-377.  [PMID:30220452]
  16. Dasgupta R, Renaud E, Goldin AB, et al. Ovarian torsion in pediatric and adolescent patients: A systematic review. J Pediatr Surg. 2018;53(7):1387-1391.  [PMID:29153467]
  17. Grabowski J, Oyetunji TA, Goldin AB, et al. The management of pilonidal disease: A systematic review. J Pediatr Surg. 2019;54(11):2210-2221.  [PMID:30948198]
  18. Rangel SJ, Calkins CM, Cowles RA, et al. Parenteral nutrition-associated cholestasis: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg. 2012;47(1):225-40.  [PMID:22244423]
  19. Gates RL, Price M, Cameron DB, et al. Non-operative management of solid organ injuries in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review. J Pediatr Surg. 2019;54(8):1519-1526.  [PMID:30773395]