The APSA Outcomes and Evidence-based Practice Committee aims to facilitate the efforts of APSA members, either individually or as an organization, and to develop clinical outcomes data and evidence-based recommendations relevant to the practice of pediatric surgery. Their mission is to support the Outcomes and Evidence-based Practice activities of the membership and to be a forum to promote collaboration and provide national leadership on these issues for the practicing pediatric surgeon.
What you'll find on this page:
What is Outcomes Research?
Outcomes research seeks to understand the end results of particular health care practices and interventions. For clinicians and patients, outcomes research provides evidence about benefits, risks, and results of treatments so they can make more informed decisions1. Outcomes research is aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome, improved health, lowered morbidity or mortality, and improvement of abnormal states2. Classically, the key feature of outcomes research was the emphasis on effectiveness (the effect of an intervention as applied to broad populations in real practice). The umbrella term "outcomes research" now loosely covers a broad range of study questions (quality of care, access, decision making, prediction rules, and effectiveness), methods (analysis of administrative databases and decision analysis), and end points (health-related quality of life and costs)3.
Health Services Research
The terms "outcomes research" and "health services research" are increasingly synonymous. Those who make a distinction between these terms regard outcomes research as measuring and addressing clinical issues and health services research as responding to policy questions3. Outcomes and health services research seek to identify the most effective and most efficient interventions, treatments, and services4. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services2.
The NIH defines a clinical trial as a prospective biomedical or behavioral research study of human subjects that is designed to answer specific questions about biomedical or behavioral interventions (such as drugs, treatments, devices, or new ways of using known drugs, treatments, or devices)5. The key feature of a clinical trial is to measure the effect of the intervention under controlled circumstances.
Lee SJ, Earle CC, Weeks JC. J Natl Cancer Inst. 2000;92:195-204
Cook DJ, Mulrow CD, Haynes RB. Ann Int Med 1997;126:376-380
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The APSA Outcomes and Evidence-based Practice Committee is writing a series of systematic reviews on topics in pediatric general surgery. Timely, useful evidence from the biomedical literature should be an integral component of clinical decision making6. A properly conducted systematic review faithfully summarizes the evidence from all relevant studies on the topic of interest, and it does so concisely and transparently. Systematic reviews are summaries of the medical literature that are performed using a thorough literature search. Each review addresses a clearly formulated question. Note: Systematic reviews aid, but do not replace, sound clinical reasoning.
Systematic Reviews currently available:
- Acute Appendicitis, Time to Appendectomy for
- Time to appendectomy for acute appendicitis: A systematic review Cameron D., Williams R., Geng Y., Gosain A., Arnold M., Guner Y., Blakely M., Downard C., Goldin A., Grabowski J., Lal D., Dasgupta R., Baird R., Gates R., Shelton J., Jancelewicz T., Rangel S., Austin M. J Peds Surg. Mar 2018; 53(3): 396–405
- Appendicitis, Antibiotics for (PPT)
- Congenital Diaphragmatic Hernia
- Management of congenital diaphragmatic hernia: A systematic review from the APSA outcomes and evidence based practice committee
Puligandla P., Grabowski J., Austin M., Hedrick H., Renaud E., Arnold M., Williams R., Graziano K., Dasgupta R., McKee M., Lopez M., Jancelewicz T., Goldin A., Downard C., Islam S. J Peds Surg. Nov 2015; 50(11); 1958–1970
- Congenital Pulmonary Airway Malformation (PPT)
- Treatment of congenital pulmonary airway malformations: a systematic review from the APSA outcomes and evidence based practice committee Downard C., Calkins C., Williams R., Renaud E., Jancelewicz T., Grabowski J., Dasgupta R., McKee M., Baird R., Austin M., Arnold M., Goldin A., Shelton J., Islam S. Ped Surg Intl. Sep 2017; 33(9): 939–953
- CVC Infections, Strategies for Prevention of (PPT)
- CVC Infections, Treatment and Prevention of (PPT)
- Empyema and NEC (PPT)
- The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee Saleem Islam S, Calkins C, Goldin A, Chen C, Downard C, Huang E, Cassidy L, Saito J, Blakely M, Rangel S, Arca M, Abdullah F, St Peter S, APSA Outcomes and Clinical Trials Committee, 2011-2012. J Peds Surg. 2012 Nov; 47(11):2101-2110
- Gastroesophageal Reflux Disease (PPT)
- Surgical management of gastroesophageal reflux disease (GERD) in children: A systematic review
Jancelewicz T., Lopez M., Downard C., Islam S., Baird R., Rangel S., Williams R., Arnold M., Lal D., Renaud E., Grabowski J., Dasgupta R., Austin M., Shelton J., Cameron D., Goldin A. J Peds Surg. Aug 2017; 52(8):1228-1238
- Gastroschisis/Omphalocele (PPT)
- Long Gap Esophageal Atresia
- Necrotizing Entercolitis (PPT)
- Treatment of necrotizing enterocolitis: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review Downard C, Renaud E, St. Peter S, Abdullah F, Islam S, Saito J, Blakely M, Huang E, Arca M, Cassidy L, Aspelund G, For the 2012 American Pediatric Surgical Association Outcomes Clinical Trials Committee. J Peds Surg. Nov 2012; 47(11):2111-2122
- Ovarian Masses
- Ovarian Torsion
- Ovarian torsion in pediatric and adolescent patients: A systematic review Roshni Dasgupta R., Renaud E., Goldin A., Baird R., Cameron D., Arnold M., Diefenbach K., Gosain A., Grabowski J., Guner Y., Jancelewicz T., Kawaguchi A., Lal D., Oyetunji T., Ricca R., Shelton J., Somme S., Williams R., Downard C. J Peds Surg
- Pilonidal Disease, Management of (PPT)
- PNAC/PNALD: Hepatoprotective Therapies for TPN-Associated Cholestasis (PPT)
- Solid Organ Injuries
- Undescended Testicle, Management of the (PPT)
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Evidence-based Medicine in Pediatric Surgery
The 97th Clinical Congress of the American College of Surgeons held in San Francisco, CA in October, 2011 included a session entitled, "Evidence-Based Medicine in Pediatric Surgery: Don't Confuse Me with Facts, My Mind is Made Up." The session was moderated by Marjorie Arca and Daniel Ostlie. View the four PowerPoint sessions below, which are made available through the APSA Website at the request of the membership. (The slides are the property of R. Moss, S. St. Peter, F. Abdullah and K. Oldham. They may not be altered or reproduced in any form.)
- Darwin to Cochrane: Evolution and Evidence-Based Medicine by R. Lawrence Moss
- Applying Results of Randomized Trials to Clinical Practice by Shawn St. Peter
- Outcomes Studies and Clinical Practice by Fizan Abdullah
- American College of Surgeons National Surgical Quality Improvement Program--Pediatric by Keith T. Oldham