Services on Demand
Jornal de Pediatria
On-line version ISSN 1678-4782
SOLA, Augusto; DIEPPA, Fernando Dominguez and ROGIDO, Marta R.. An evident view of evidence-based pratice in perinatal medicine: absence of evidence is not evidence of absence. J. Pediatr. (Rio J.) [online]. 2007, vol.83, n.5, pp. 395-414. ISSN 1678-4782. http://dx.doi.org/10.2223/JPED.1702.
OBJECTIVE: To provide valuable elements and some humor in this so-called era of "evidence-based practice" with the aim of helping clinicians make better choices in the care they deliver based on evidence, not simply or exclusively based on a randomized clinical trial (RCT) or meta-analysis (which may not be evidence). SOURCES: Books and peer-reviewed articles are quoted and listed in the bibliography. Evidence of life, learning from our own mistakes and many other evident facts that support this review are not quoted. SUMMARY OF THE FINDINGS: 1) "Absence of evidence is not evidence of absence" and "lack of evidence of effect does not mean evidence of no effect". 2) RCTs with "negative" results and those with "positive" results, but without outcomes that matter, often cannot conclude what they conclude. 3) Non-randomized clinical trials and practical trials may be important. 4) Research to prove is different than research to improve. 5) Clinical choice must assess effects on outcomes that matter to patients and their parents. 6) Quantifying adverse outcomes, number needed to damage and to treat is not that simple. CONCLUSIONS: Significant challenges inherent to health service research must be correlated to possible clinical applications using tools to have a more "evident view of evidence-based practice" in perinatal medicine, recalling that absence of evidence is not evidence of absence.
Keywords : Evidence-based medicine; number needed to treat; randomized trials; outcome variables; treatment effects; critical reading; statistical significance.