Critical Appraisal of Important Articles

The POSNA Evidence Based Practice Committee (EBP) Levels of Evidence Summaries (LOEs) are succinct evaluations of randomized controlled trials in pediatric orthopaedic surgery. Published studies since 2005 have been selected and reviewed by members of the Evidence Practice Committee and summarized in standard fashion. The aim is to serve as an evidence-based repository for quick reference to available high level evidence as well as resource to identify gaps in the current research and identify opportunities for future investigation.

Methodology:

Over 40 published randomized controlled trials were initially identified by Dodwell et. al. (PubMed). These studies and others were selected and reviewed by members of the POSNA EBP Committee in standardized format that includes the purpose and design of the study, intervention, measurements, outcomes, results, clinical significance and reviewer comments with clinical significance.

Submission Process:

Level of evidence summaries are voluntarily submitted by members of the POSNA Evidence Based Practice Committee using a standardized summary format.

Appropriate Use Criteria (AUC)

Peds Orthopaedic AUCs	Details
Pediatric Supracondylar Humerus Fractures Issued: 9/5/2014	WebApp Report
Management of Pediatric Supracondylar Humerus Fractures with Vascular Injury Issued: 6/12/2015	WebApp Report
Treatment of Osteochondritis Dissecans (OCD) Issued: 12/4/2015	WebApp Report

What are Appropriate Use Criteria?

Appropriate Use Criteria (AUC) specify when it is appropriate to use a procedure. An “appropriate” procedure is one for which the expected health benefits exceed the expected health risks by a wide margin. Often, sound data is not available or does not provide evidence that is detailed enough to apply to the full range of patients seen in everyday clinical practice. Nevertheless, physicians must make daily decisions about when to use or not use a particular procedure. AUCs facilitate these decisions by combining the best available scientific evidence with the collective judgment of physicians in order to determine the appropriateness of performing a procedure.

What procedures are addressed by Appropriate Use Criteria?

AUC topics focus on widely and frequently used procedures whose effectiveness is supported by evidence-based information. Additionally, AUC topics could be procedures that consume significant resources, have wide variations in their use (e.g. geographic), or are associated with substantial morbidity and mortality. AUC topics are derived from AAOS Clinical Practice Guidelines that establish the effectiveness of various procedures for a given disease, disorder, or condition. AUCs then address the patients in which these procedures are appropriate given the nuances of everyday clinical practice.

Why develop Appropriate Use Criteria?

AUCs are developed to ensure the highest QUALITY of care for patients undergoing musculoskeletal procedures

How are Appropriate Use Criteria developed?

The AAOS uses the RAND/UCLA Appropriateness Method to develop AUCs. AAOS AUCs are developed using evidence-based information in conjunction with the clinical expertise of physicians from multiple medical specialties in order to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions.

Who develops Appropriate Use Criteria?

"Panels" of AAOS & Specialty Society volunteer physicians that operate independently of each other develop AAOS Appropriate Use Criteria.

You can learn more about Appropriate Use Criteria at OrthoGuidelines.org.

Clinical Practice Guidelines (CPG)

Evidence-Based Clinical Practice Guidelines are based on a systematic review of published studies. Multidisciplinary guideline development groups construct Evidence-Based Clinical Practice Guidelines to serve as an educational tool based on an assessment of the current published scientific and clinical information and accepted approaches to treatment.

Pediatric Orthopaedic CPG's	Issued By	Details
Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age	AAOS	Report
Diagnosis and Treatment of Osteochondritis Dissecans	AAOS	Report
Management of Anterior Cruciate Ligament Injuries	AAOS	Report
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures	AAOS	Report
Treatment of Pediatric Diaphyseal Femur Fractures	AAOS	Report
Treatment of Pediatric Supracondylar Humerus Fractures	AAOS	Report

You can learn more about Clinical Practice Guidelines at OrthoGuidelines.org.

Clinical Performance Measures (CPM)

Orthopaedic surgeons are the most qualified professionals to develop and evaluate quality of care measures for patients with musculoskeletal conditions. It is crucial that orthopaedic surgeons retain a leadership position in defining quality of orthopaedic care.

Pediatric Orthopaedic CPM's: None To Date

Learn More:

National Quality Measures Clearinghouse (NQMC) - The US Department of Health and Human Services (HHS), Agency for Healthcare Research and Quality (AHRQ)
National Quality Forum

Physician Education

Evidence Based Orthopaedics

Quality Tools