Introduction: Recognition of evidence based medicine (EBM) has been well documented and supported across surgical subspecialties for over a decade. We aimed to quantify the levels of evidence (LOE) of publications in the neurosurgical literature and compare this to a previously published baseline.
Methods: Clinical neurosurgical literature published in Neurosurgery, from October 2009 - September 2010 was reviewed. Articles were evaluated by two independent reviewers to determine their LOE based on the criteria published by the Centre for Evidence Based Medicine. This was compared to a LOE benchmark for the year 2000 (Rothoerl, 2005) as well as to other surgical specialties.
Results: Four hundred forty-three articles were reviewed and 368 met eligibility criteria. Five studies (1%) were Level I, 26 (7%) were Level II, 29 (8%) were Level III, 115 (31%) were Level IV, and 94 (26%) were Level V. There was no significant difference in the distribution of levels of evidence between the year 2000 and 2010. Publications of larger sample sizes were associated with higher levels of evidence (Levels I/II) (p<0.01). No other variables, including number of authors, neurosurgical field, or number of collaborating centres, were significantly associated with higher LOE. In comparison to other surgical specialties, the ratio of higher levels of evidence to lower levels in neurosurgery was below the mean.
Conclusions: Over the past decade, the neurosurgical literature has remained unchanged in terms of the mean level of evidence published annually, with Level I evidence still being least represented, and on average, falls below the mean across other surgical specialties.
Patient Care: Improving the ability of the neurosurgeon to critically appraise literature and grade relative strengths of recommendations is integral to advancing our evidence-based approach towards patient care.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Understand the various Levels of Evidence for clinical research and their relationship to quality of the literature.
2) Describe the importance of Levels of Evidence and the standing of Neurosurgical literature in comparison to other subspecialties.
3) Critically analyze their own research to identify areas of improvement for increasing publication quality.