Where's the Evidence? Evidence-Based Orthopaedic Trauma: A New Section in the Journal

Over the last several years, the concepts and ideas attributed to and labeled collectively as evidence-based medicine (EBM) have become a part of our daily clinical lives, and we increasingly hear about evidence-based guidelines, evidence-based care paths, and evidence-based questions and solutions. The controversy has shifted from whether to implement the new concepts to how to do so sensibly and efficiently, while avoiding potential problems associated with a number of misconceptions about what EBM is and what it is not. The EBM-related concepts of hierarchy of evidence, meta-analyses, confidence intervals, and study design are so widespread, that surgeons, researchers, and health care personnel willing to use today's surgical literature with understanding have no choice but to become familiar with evidence-based medicine principles and methodologies. Realizing the ever-increasing demands on our readers to move towards the language of evidence-based medicine, the Journal of Orthopaedic Trauma has instituted a new section entitled, “Evidence-Based Orthopaedic Trauma,” which aims to provide readers with a summary of the published literature on a variety of topics. This new section will complement our “Case Controversy” section by providing a brief summation of the relevant and important literature, allowing readers to evaluate expert opinion in the context of available evidence. In addition, each evidence summary will provide a review of one or more important concepts in health research methodology. In the process of adopting this new section, readers must avoid common misconceptions about evidence-based medicine. Critics have mistakenly suggested that evidence equates to the results of randomized trials, or that statistical significance automatically means clinical relevance. This is not true. Often the best available evidence may come from nonrandomized studies that are important in developing hypotheses for future research. Although evidence-based medicine is sometimes perceived as a strict adherence to randomized trials, it more accurately involves informed and effective use of all types of evidence, but particularly evidence from the medical literature, in patient care. With the ever-increasing amount of available information, surgeons must consider a shift in paradigm from traditional practice to one that involves question formulation, validity assessment of available studies, and appropriate application of research evidence to individual patients.