Editorial: Evidence-Based Medicine

Evidence-based medicine integrates the best available evidence of clinical expertise and patient preference in making the best decisions about patient care. This concept represents excellence and is firmly established in the pursuit of best medical practice. It has been applied to almost all subspecialties in medicine including orthopaedics. It is the focus in peer-reviewed journals and discussed in consensus statements of medical societies. 1,2 Studies that eliminate the most bias and control for most confounding factors are ranked high, with randomised controlled trials being highest, and case reports and expert opinions being lowest. A proposed treatment is likely to be accepted if the risk-to-benefit ratio is clearly shown. 3,4 Even in the absence of high-level scientific studies, a collection of lower-grade studies can provide some guidance for clinical decision making. Many journals state the level of evidence of each article to assist readers in determining the strength of the information presented. For patients undergoing hip fracture surgery, it is important to mitigate against the risk of venous thromboembolism, while minimising the risk of bleeding due to pharmacologic prophylaxis. In this issue, Leonidou et al. 5 emphasise the need for early