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Evidence Based Medicine

Evidence Based Medicine. 指導醫師：駱至誠 教授 Clerk ：林旻暭、洪俊宇、黃冠慈. Clinical Scenario. A four month-old boy with left side inguinal hernia receives inguinal herniotomy by the open technique Question:

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Evidence Based Medicine

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  1. Evidence Based Medicine 指導醫師：駱至誠 教授 Clerk：林旻暭、洪俊宇、黃冠慈

  2. Clinical Scenario • A four month-old boy with left side inguinal hernia receives inguinal herniotomy by the open technique Question: Does it benefits from routine contralateral exploration at the time of the primary inguinal herniotomy?

  3. Introduction of Inguinal Hernia

  4. Inguinal Hernia • An inguinal hernia develops when the processus vaginalis fails to obliterate during late gestation, allowing communication between the abdominal cavity and the inguinal canal to persist. Abdominal contents can then herniate into the inguinal canal.

  5. Inguinal Hernia • The vast majority of hernias in children are indirect, with contents protruding through the internal inguinal ring into the inguinal canal.

  6. 5 A’s

  7. Patient/Problem: A 4 month-old child with left side inguinal hernia Intervention: Contralateral exploration Comparison: Unilateral exploration Outcome: Incidence of metachronous contralateral inguinal hernia

  8. Acquire Database: PubMed Keywords: Metachronous contralateral inguinal hernia

  9. Metachronous contralateral inguinal hernia

  10. The evidence pyramid

  11. Level of evidence

  12. Critical Appraisal of systemic review paper 10 question for Critical Appraisal of Systemic review Is the trial valid? (Q1~Q5) What are the results? (Q6~Q7) Will the results help locally? (Q8~Q10)

  13. Q1.Did the review ask a clearly-focused question?

  14. Q2. Did the review include the right type of studies?

  15. Q3.Did the reviewers try to identify all relevant studies?

  16. Q4. Did the reviewers assess the quality of the included studies?

  17. Q5.If the results of the studies have been combined, was it reasonable to do so? • These review article included study with evidence level II-a and II-b so there were noheterogeneity(I2) and Westley score for evaluation

  18. Q6. How are the results presented and what is the main result?

  19. Q7. How precise are the result? • Same as Q5

  20. Q8. Can the result be applied to the local population? • Patient 的data來自61個studies • Patients的年齡從GA 31 wks到18 y/o並沒有特別提起patients的種族 不知道

  21. Q9. Were all important outcomes considered? • Develop MCIH following a unilateral inguinal herniotomy: (49568 patients) • 5.76%(95%CI:5.55-5.97%) • NNT(number need to treat):18 (95%CI:16.8-18%) • Gender

  22. Q9. Were all important outcomes considered? • Age • <6 month: 183/1470 • >6month: 144/2044 • p<0.0001 • NNT for age<6 month:9 (95%CI:7.1-9.3)

  23. Q9. Were all important outcomes considered? • Laterality of initial hernia(22104 patients) • P<0.0001 yes

  24. Q9. Should policy of practice change as a result of the evidence contained in this review?

  25. Audit • A four month-old boy with left side inguinal hernia receives inguinal herniotomy by the open technique • Risk factor: left side、four-month • 並不作routine的explore,告知risk factor並和家長討論治療計畫

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