Sizing up the evidence
Evidence-based medicine, defined literally, depends on the existence of studies that justify treatment decisions. But, too often, practitioners who specialize in pediatric lower extremity care find that the only evidence they have to draw on involves studies done in adults, not children.
In some cases, the same concepts seem to apply to both patient populations. Research from the University of Wisconsin in Madison, for example, suggests that balance training and prophylactic ankle bracing can be just as effective for preventing ankle sprains in high school athletes as in their adult counterparts (see “Treating and preventing ankle sprains in children,” page 9).
But other examples serve as a reminder that children are not just small adults. Researchers from Cincinnati Children’s Hospital have found that the Balance Error Scoring System, a popular test for identifying and monitoring postconcussion balance deficits, is not as clinically useful in children as it is in adults (see “Study questions utility of adult balance test in concussed kids,” page 6).
The problem is that studies like those mentioned above are rare. That means pediatric clinicians often must decide on their own whether to base treatment for children on research done in adults. This requires practitioners to rely on their clinical experience and knowledge of key differences between adults and children with regard to such factors as anatomy, biomechanics, lifestyle priorities, and ability to follow instructions.
In the real world, evidence-based medicine isn’t just about blindly following the literature. It can also be about using published studies as a starting point, and then making educated decisions about the extent to which those studies apply to your patients—no matter how old they are.
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