Editorial. Classes of evidence in neurosurgery

Rutka, James T.

doi:10.3171/2016.4.jns161067

Cited by 17 publications

(9 citation statements)

References 8 publications

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“…and Yarascavitch et al [ 5 ] published investigations into the levels of evidence in the neurosurgical literature in 2003 and 2012, respectively. These studies assigned a level of evidence to all published clinical papers in three major neurosurgical journals for the years 1999 and 2009-2010, respectively, graded according to the study design shown in Table 1 [ 5 , 8 , 9 ]. The authors found that 22.8% and 10.3% of evidence was considered higher-level evidence (level I or level II).…”

Section: Introductionmentioning

confidence: 99%

Importance and Presence of High-Quality Evidence for Clinical Decisions in Neurosurgery: International Survey of Neurosurgeons

Martens¹,

Jong²,

Rovers³

et al. 2018

Interact J Med Res

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BackgroundThe publication rate of neurosurgical guidelines has increased tremendously over the past decade; however, only a small proportion of clinical decisions appear to be based on high-quality evidence.ObjectiveThe aim was to evaluate the evidence available within neurosurgery and its value within clinical practice according to neurosurgeons.MethodsA Web-based survey was sent to 2552 neurosurgeons, who were members of the European Association of Neurosurgical Societies.ResultsThe response rate to the survey was 6.78% (173/2552). According to 48.6% (84/173) of the respondents, neurosurgery clinical practices are based on less evidence than other medical specialties and not enough high-quality evidence is available; however, 84.4% (146/173) of the respondents believed neurosurgery is amenable to evidence. Of the respondents, 59.0% (102/173) considered the neurosurgical guidelines in their hospital to be based on high-quality evidence, most of whom considered their own treatments to be based on high-quality (level I and/or level II) data (84.3%, 86/102; significantly more than for the neurosurgeons who did not consider the hospital guidelines to be based on high-quality evidence: 55%, 12/22; P<.001). Also, more neurosurgeons with formal training believed they could understand, criticize, and interpret statistical outcomes presented in journals than those without formal training (93%, 56/60 and 68%, 57/84 respectively; P<.001).ConclusionsAccording to the respondents, neurosurgery is based on high-quality evidence less often than other medical specialties. The results of the survey indicate that formal training in evidence-based medicine would enable neurosurgeons to better understand, criticize, and interpret statistical outcomes presented in journals.

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Section: Introductionmentioning

confidence: 99%

Importance and Presence of High-Quality Evidence for Clinical Decisions in Neurosurgery: International Survey of Neurosurgeons

Martens¹,

Jong²,

Rovers³

et al. 2018

Interact J Med Res

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“…The OCEM class is an important factor in determining the magnitude of the data and evidence provided within an article and is the driver of evidence-based medicine. Recently, neurosurgical journals have started to include this information in the metadata associated with an article (e.g., Rutka, 39 2016). Of the 77 studies for which the OCEM evidence class was available or could be assigned, we found that most articles were of class III evidence (i.e., retrospective cohort studies, case-controlled studies, or meta-analyses [e.g., systematic reviews]).…”

Section: Discussionmentioning

confidence: 99%

Local Field Potentials in Deep Brain Stimulation: Investigation of the Most Cited Articles

Mishra

Shah

McBriar

et al. 2023

World Neurosurgery: X

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“…The best possible conclusion that statistical methods can obtain comes from meta-analyses of controlled clinical trials in which the main outcome is a quantitative one, derived from data with normal distribution, which provides the greater possible power, [70–72] but no randomized controlled clinical trial has attempted to answer the question, and an appropriate design is not feasible, [31] because of this, current attempts to correctly answer the question are based on scanty studies of limited designs, with nominal outcome variables, that produce a low or very low level of evidence [53,54] …”

Section: Discussionmentioning

confidence: 99%

Extent of resection and survival in patients with glioblastoma multiforme

et al. 2021

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Background: Glioblastoma multiforme (GBM) owes an ominous prognosis: its mean overall survival is 14 months. The extent of surgical resection (ESR) highlights among factors in which an association has been found to a somewhat better prognosis. However, the association between greater ESR and prolonged overall (OS) survival is not a constant finding nor a proven cause-and-effect phenomenon. To our objective is to establish the strength of association between ESR and OS in patients with GBM through a systematic review and meta-analysis. Methods: In accordance with PRISMA-P recommendations, we conducted a systematic literature search; we included studies with adult patients who had undergone craniotomy for GBM. Our primary outcome is overall postoperative survival at 12 and 24 months. We reviewed 180 studies, excluded 158, and eliminated 8; 14 studies that suited our requirements were analyzed. Results: The initial level of evidence of all studies is low, and it may be degraded to very low according to GRADE criteria because of design issues. The definition of different levels of the extent of resection is heterogeneous and poorly defined. We found a great amount of variation in the methodology of the operation and the adjuvant treatment protocol. The combined result for relative risk (RR) for OS for 12 months analysis is 1.25 [95% confidence interval (95% CI) 1.14–1.36, P < .01], absolute risk reduction (ARR) of 15.7% (95% CI 11.9–19.4), relative risk reduction (RRR) of 0.24 (95% CI 0.18–0.31), number needed to treat (NNT) 6; for 24-month analysis RR is 1.59 (95% CI 1.11–2.26, P < .01) ARR of 11.5% (95% CI 7.7–15.1), relative risk reduction (RRR) of 0.53 (95% CI 0.33–0.76), (NNT) 9. In each term analysis, the proportion of alive patients who underwent more extensive resection is significantly higher than those who underwent subtotal resection. Conclusion: Our results sustain a weak but statistically significant association between the ESR and OS in patients with GBM obtained from observational studies with a very low level of evidence according to GRADE criteria. As a consequence, any estimate of effect is very uncertain. Current information cannot sustain a cause-and-effect relationship between these variables.

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Editorial. Classes of evidence in neurosurgery

Cited by 17 publications

References 8 publications

Importance and Presence of High-Quality Evidence for Clinical Decisions in Neurosurgery: International Survey of Neurosurgeons

Importance and Presence of High-Quality Evidence for Clinical Decisions in Neurosurgery: International Survey of Neurosurgeons

Local Field Potentials in Deep Brain Stimulation: Investigation of the Most Cited Articles

Extent of resection and survival in patients with glioblastoma multiforme

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