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Examine the historical origin and structure of evidence-level hierarchies and evaluate their practical application, interpretation, and quality within plastic surgery research.

June 25, 2011Plastic & Reconstructive SurgeryOpen Access

The Levels of Evidence and Their Role in Evidence-Based Medicine

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Examine the historical origin and structure of evidence-level hierarchies and evaluate their practical application, interpretation, and quality within plastic surgery research.
Reviewed foundational evidence grading systems originating from the Canadian Task Force on the Periodic Health Examination and David Sackett.
Assessed historical trends in evidence tiers across plastic surgery literature from 1978 to 2009 along with trial quality assessment metrics.
Level IV and V publications in Plastic and Reconstructive Surgery declined from 93% in 1983 to 87% in 2003, whereas Level I trials across five plastic surgery journals increased from 1 in 1978 to 32 in 2009.
Surgical trials frequently lacked adequate methodological quality; an analysis of 72 orthopedic trials reported a mean Jadad quality score of 68%, with 60% scoring below the 75% quality threshold.
Higher-tier evidence resolved historic clinical misconceptions generated by case reports, such as demonstrating no increased lymphoma risk from silicone breast implants (standardized incidence ratio 0.89; 95% CI, 0.67–1.18).

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Implication

Methodological review demonstrates evolving hierarchies of evidence in plastic surgery, highlighting the need to critically appraise study quality alongside evidence tiers.

Cite This Study

Burns et al. (2011) studied this question.

synapsesocial.com/papers/69d7cdda61e2ce1627d18158 https://doi.org/10.1097/prs.0b013e318219c171

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Implication

Methodological review demonstrates evolving hierarchies of evidence in plastic surgery, highlighting the need to critically appraise study quality alongside evidence tiers.

The Levels of Evidence and Their Role in Evidence-Based Medicine

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The Levels of Evidence and Their Role in Evidence-Based Medicine

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Implication

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