Evidence-based pediatric pulmonary medicine: how can it help?

Abstract

Evidence-based medicine aims to identify, critically appraise, and apply the best available evidence in making decisions about the care of patients. These aims are similar to those conscientious clinicians have always sought to achieve, but an evidence-based approach applies a systematic and rigorous methodology to this process to ensure that the evidence applied is relevant and of high quality. Because of the volume of potentially relevant information that needs to be accessed from the medical literature, many clinicians rely on reviews of the evidence. Systematic reviews provide summaries of the results of evidence-based healthcare, which can be made available to clinicians, healthcare administrators, and patients. The use of explicit, systematic methods in reviews limits bias (systematic errors) and reduces random errors (simple mistakes), thus providing reliable results on which to draw conclusions and make decisions. Meta-analysis is the use of statistical methods to summarize the results of independent studies. When used appropriately, meta-analysis can provide more precise estimates of the effects of healthcare than those derived from the individual studies included in a review. Childhood respiratory diseases can be a challenging area in which to undertake clinical research. These challenges include diagnostic uncertainty, lack of objective endpoints, and aspects of generalizability of randomized controlled trials. Despite these difficulties, there are now many examples of systematic reviews and evidence-based approaches in pediatric pulmonology. If applied appropriately, they can ensure that management of patients is based on clinically useful diagnostic tests and treatments that have been shown to be effective and not harmful.