Evidence-based Models for Clinical Care in Pediatric and Adolescent Gynecology

Abstract

Evidence-based management models for clinical care are gaining in credence and demand. However such models based on randomized controlled trials are difficult to achieve in children and adolescents. This is especially true in Pediatric and Adolescent Gynecology where certain outcomes may be infrequent and randomized designs are rarely feasible. As a result evidence in pediatric and adolescent gynecology comes primarily from non-randomized studies where single studies rarely provide a definitive answer to a clinical question. Consequently the meta-analysis of non-randomized studies using data from existing databases (case-control cohort cross sectional case series etc.) becomes an important tool for decision-making. Although metaanalysis restricted to randomized controlled trials (RCT) are usually preferred to the meta-analysis of observational studies the numbers of the latter have increased substantially in the past several years. For this reason familiarity with the tools of meta-analysis for observational studies has taken on an increasing importance for editors authors reviewers and readers of this journal. The Journal of Pediatric and Adolescent Gynecology has frequently published systematic and objective reviews of the available evidence on a selected topic. However these narrative reviews are not usually designed to provide a single quantitative estimate of the absolute or relative difference in effect size between treatment options. The tools of meta-analysis are designed to provide a mathematical estimate of the effect size when one pools the results of independent studies. In the world of finite health resources these pooled estimates are being used more and more as the final arbitrator of a treatment’s effect. (excerpt)