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Chapter 13 - Evidence-based radiology and child abuse

from Section I - Skeletal trauma

Published online by Cambridge University Press:  05 September 2015

By
Christopher S. Greeley
Edited by
Paul K. Kleinman
Christopher S. Greeley
Affiliation:
Professor of Pediatrics at the Center for Clinical Research and Evidence-Based Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
Paul K. Kleinman
Affiliation:
Children's Hospital Boston
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Summary

Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannized by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients. Sackett et al. (1).

EBM and radiology

Much of the foundation of evidence-based medicine (EBM) originated in McMaster University (Ontario, Canada) in the 1990s. Drs. David Sackett and Gordon Guyatt led the Evidence-Based Working Group (2) that framed a “new paradigm” of patient care and medical scholarship which has continued to grow to the present day. At its core, EBM is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (1). In this way, EBM utilizes the experiences and clinical judgment of the practitioner, but overlays a systematic analysis and critical appraisal of the appropriate published literature. The Working Group presented a medical practice that was no longer based solely upon intuition, anecdote, or supposition, but incorporated the assessment of evidence collected through a systematic literature search and reflected upon the clinical practice and experience of the physician. This paradigm shift required the practitioner to develop new skills: systematic literature appraisal, evidence quality rating, and the continued reassessment of personal biases.

There are some excellent comprehensive resources available for a deeper description of EBM (3, 4). While a complete treatise on EBM cannot be replicated here, an understanding of some of the underpinning principles will aid the practitioner in appreciating its importance in the evaluation of suspected child abuse. The framework of EBM has five fundamental steps as outlined by Dr. Sackett (2, 5) and constitute the Critical Appraisal Exercise (2):

  1. Convert these information needs into answerable questions.

  2. Track down, with maximum efficiency, the best evidence with which to answer them (and making increasing use of secondary sources of the best evidence).

  3. Critically appraise that evidence for its validity (closeness to the truth) and usefulness (clinical applicability).

  4. Integrate the appraisal with clinical expertise and apply the results in clinical practice.

  5. Evaluate one’s own performance.

Type
Chapter
Information
Diagnostic Imaging of Child Abuse , pp. 309 - 323
Publisher: Cambridge University Press
Print publication year: 2015

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  • Evidence-based radiology and child abuse
    • By Christopher S. Greeley, Professor of Pediatrics at the Center for Clinical Research and Evidence-Based Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
  • Edited by Paul K. Kleinman
  • Book: Diagnostic Imaging of Child Abuse
  • Online publication: 05 September 2015
  • Chapter DOI: https://doi.org/10.1017/CBO9780511862366.021
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  • Evidence-based radiology and child abuse
    • By Christopher S. Greeley, Professor of Pediatrics at the Center for Clinical Research and Evidence-Based Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
  • Edited by Paul K. Kleinman
  • Book: Diagnostic Imaging of Child Abuse
  • Online publication: 05 September 2015
  • Chapter DOI: https://doi.org/10.1017/CBO9780511862366.021
Available formats
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  • Evidence-based radiology and child abuse
    • By Christopher S. Greeley, Professor of Pediatrics at the Center for Clinical Research and Evidence-Based Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
  • Edited by Paul K. Kleinman
  • Book: Diagnostic Imaging of Child Abuse
  • Online publication: 05 September 2015
  • Chapter DOI: https://doi.org/10.1017/CBO9780511862366.021
Available formats
×