Evidence-based practice in oral and maxillofacial surgery. Audit of one training center

Abstract

Objectives: To evaluate the proportion of evidence-based interventions in the field of Oral and Maxillofacial Surgery (OMS) in a regional training centre. We also evaluated the levels of evidence present in the OMS literature, and the current availability of evidence in various diagnostic categories. Methods: A prospective clinical audit was carried out within the discipline of OMS, University of Hong Kong, in February 2005, for a period of six months to investigate the extent of evidencebased practice. Consecutive diagnosis and intervention pairs were identified and recorded through standardized charts in randomly selected clinical sessions. A corresponding literature search using Medline and the Cochrane Library was performed to identify best current evidence, then analysed and graded according to the evidence. Results: Two hundred and seventy three out of 500 cases were eligible for evaluation while the rest were excluded based on four defined exclusion criteria. A majority of interventions (n = 195, 71.4%) were found to be evidence based. Seventy eight (28.6%) interventions were found to be not evidence based. Among the evidence, a majority (56.1%) were level 5 which are mainly case series, and 36% were level 3 or above, which are randomized control trial (RCT) (level 3), meta-analysis of RCTs (level 2) or systematic review of RCTs (level 1). There was no statistically significant difference in the proportion of evidence-based practice between specialists and trainees in OMS who treated the patients. Conclusion: This study demonstrated that most interventions prescribed in this OMS training centre were evidence based and the proportion was comparable to that reported by other specialties.