Comparison of reports of randomized controlled trials and systematic reviews in surgical journals: literature review.
ABSTRACT Randomized controlled trials and systematic reviews of such trials are the gold standard for assessing the effectiveness of interventions. There have been concerns about the anecdotal evidence underpinning many of the interventions used and introduced into surgical care. The American College of Surgeons has prioritized the need for more trials and systematic reviews of trials. To investigate the assertion that the methodological quality of studies conducted in surgery is in general poor and to assess the possible impact of new policy developments in the US, we sought to compare the number and proportion of published randomized controlled trials and systematic reviews in the leading two US and UK general surgical journals. Two reviewers systematically and independently hand searched all issues of these journals over a 12-month period to identify randomised controlled trials and systematic reviews.
Systematic searching and independent abstraction of data from all volumes of the top two general surgical journals published in the USA and the UK in 2004.
519 original reports in UK journals and 616 original reports in USA journals.
Number and proportion of randomized controlled trials and systematic reviews.
Overall, the proportion of randomized controlled trials in all four journals was 5.6% (95% confidence interval [CI] 4.4-7.0) and 5.2% (95% CI 4.1-6.7) for systematic reviews. For journals published in the UK 29/519 (5.6%) of the publications were reports of randomized controlled trials, and for the USA journals this figure was 34/616 (5.5%); odds ratio [OR]=0.99, 95%CI 0.6-1.6; P=0.96. Systematic reviews were significantly more commonly reported in the UK journals: UK 37/519 (7.1%) versus USA 22/616 (3.6%); OR=0.48, 95%CI 0.3-0.8; P<0.01.
The concerns expressed almost a decade ago remain valid: there are still very few reports of randomized controlled trials and systematic reviews published in leading USA and UK surgical journals, with relatively little difference between these countries in the proportion of reported studies employing these designs. The American College of Surgeons initiative has yet to make an impact.
BMJ (Clinical research ed.). 07/2002; 324(7351):1448-51.
Article: Surgical practice is evidence based.[show abstract] [hide abstract]
ABSTRACT: The quality of surgical research, and particularly the reluctance of surgeons to perform randomized controlled trials, has been criticized. The proportion of surgical treatments supported by satisfactory scientific evidence has not been evaluated previously. A 1-month prospective audit was performed of 100 surgical inpatients admitted under two consultants in a general surgical/vascular unit at an urban teaching hospital; the main illness and interventions were agreed through group discussions in each case. The literature concerning the efficacy of each treatment was reviewed, and the evidence was categorized as: (1) supported by randomized controlled trial evidence; (2) sufficient other evidence of efficacy to make a placebo-controlled trial unethical; or (3) neither of the above. Of the 100 patients studied, 95 (95 per cent confidence interval (c.i.) 89-98) received treatment based on satisfactory evidence (categories 1 and 2) and, of these, 24 patients (95 per cent c.i. 17-35) received treatments based on randomized controlled trial evidence and 71 had treatments based on other convincing evidence (95 per cent c.i. 62-80). Inpatient general surgery is 'evidence based', but the proportion of surgical treatments supported by randomized controlled trial evidence is much smaller than that found in general medicine. Some reasons for this are clear, but the extent to which surgical practice needs to be reevaluated is not. Current methods for classifying and describing evidence in therapeutic studies need improvement.British Journal of Surgery 10/1997; 84(9):1220-3. · 4.61 Impact Factor
[show abstract] [hide abstract]
ABSTRACT: Surgeons have lagged behind physicians and oncologists in embracing randomized controlled clinical trials. This paper suggests that a complete, accurate and objective comparison of the outcome of a novel intervention with that of a traditional intervention in previous years, or in another surgical group, can yield valuable information and can lead surgeons to improve their practice. There has recently been a decline in the number of randomized controlled trials published in The British Journal of Surgery; this may reflect the unwillingness of many patients to allow their surgical treatment to be decided by chance.British Journal of Surgery 09/1993; 80(8):964-6. · 4.61 Impact Factor