Evidence Based Orthopaedics

Quality Tools

  • Level of Evidence Summaries (LOE)
  • Appropriate Use Criteria (AUC)
  • Clinical Practice Guidelines (CPG)
  • Clinical Performance Measures (CPM)

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.
NOTE: You must be a POSNA member to access the LOE Database.


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
Management of Pediatric Supracondylar Humerus Fractures with Vascular Injury
Issued: 6/12/2015
Treatment of Osteochondritis Dissecans (OCD)
Issued: 12/4/2015

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

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