Krahn Jan, Sauerland Stefan, Rixen Dieter, Gregor Sven, Bouillon Bertil, Neugebauer Edmund A M
Institute for Research in Operative Medicine, Faculty of Medicine, University of Witten/Herdecke, Ostmerheimer Strasse 200, Cologne, Germany.
Arch Orthop Trauma Surg. 2006 Mar;126(2):88-92. doi: 10.1007/s00402-005-0095-0. Epub 2006 Jan 3.
Although the word evidence-based medicine (EBM) has gained wide popularity, only a few studies have evaluated how EBM works in clinical practice.
We have prospectively evaluated the feasibility of evidence-based trauma surgery. Orthopaedic trauma surgeons were asked to produce clinical questions related to the treatment of current patients. An informaticist searched the literature (Medline, Cochrane Library, practice guidelines and textbooks) and reported the findings on every following day. The study's main endpoints were the rate of questions for which relevant evidence (>level V) was available and the time necessary to find and critically appraise medical evidence.
In total, 44 EBM questions were formulated, mainly concerning treatment options. PubMed was searched for 39 questions, textbooks for 14, the Cochrane Library for 11, online guidelines for 9 and other sources were used for 4 questions. On average, 157 text items (three per questions) were identified as potentially relevant. Journal articles predominated (83%) over textbooks (10%). Sixty-eight percent of the questions (30 of 44) were answered, either on the basis level 1 (n=13 questions), level 2 (n=6), or level 4 evidence (n=14). Trying to answer a question required 53 min on average, split up between 39 min of database searches and 25 min of obtaining full text articles. In four cases, the evidence suggested a change in clinical management. The physicians were very appreciative of our project and found the provided evidence very helpful for their clinical decisions.
Time will be the main barrier against the introduction of clinical EBM. It is likely that clinicians reduce EBM to those situations where evidence is likely to be found. Although the impact of EBM on patient-care was limited, the concept of EBM was successfully implemented.
尽管循证医学（EBM）一词已广受欢迎，但仅有少数研究评估了循证医学在临床实践中的运作方式。
我们前瞻性地评估了循证创伤外科的可行性。要求骨科创伤外科医生提出与当前患者治疗相关的临床问题。一名信息专家检索文献（医学索引数据库、考克兰图书馆、实践指南和教科书），并在随后的每一天报告检索结果。该研究的主要终点是可获得相关证据（>V级）的问题比例以及查找和严格评估医学证据所需的时间。
总共提出了44个循证医学问题，主要涉及治疗方案。针对39个问题检索了医学索引数据库，14个问题查阅了教科书，11个问题检索了考克兰图书馆，9个问题查阅了在线指南，4个问题使用了其他来源。平均而言，确定了157篇文本（每个问题3篇）可能相关。期刊文章占主导（83%），教科书占10%。68%的问题（44个中的30个）得到了回答，依据的证据等级为1级（n = 13个问题）、2级（n = 6个）或4级（n = 14个）。回答一个问题平均需要53分钟，其中39分钟用于数据库检索，25分钟用于获取全文。在4个案例中，证据表明临床管理需要改变。医生们对我们的项目非常赞赏，并发现所提供的证据对他们的临床决策非常有帮助。
时间将是引入临床循证医学的主要障碍。临床医生可能会将循证医学应用局限于可能找到证据的情况。尽管循证医学对患者护理的影响有限，但循证医学的概念已成功实施。
