Evidence-based Medicine and

Pediatrics:
Opportunities and Challenges

V. Fan Tait, MD, FAAP

American Academy of Pediatrics
Director, Dept. of Community and Specialty Pediatrics
Evidence-based Medicine

Practicing EBM requires a clear delineation of

relevant clinical questions, a thorough search of
the literature relating to the questions, a critical
appraisal of available evidence and its
applicability to the clinical situation, and a
balanced application of the conclusions to the
clinical problem.
Jaeschke and Guyatt Seminars in Medical Practice 1999
Challenges of Evidence-based
Research in Pediatrics
Not just little adults
Variety of diseases and interventions
Developmental aspects of pediatrics
Concerns of parents and pediatricians
Evidence is often absent or conflicting
Asking appropriate research questions
Evaluation of outcomes
Child Health Interventions

Whenever possible, evidence-based

Evidence informedbased on scientific

data

Expert consensus
Child Health Interventions
Evidence-based interventions
Evidence-informed interventions
AAP policy statements/clinical
reports/technical reports/clinical practice
guidelines
Other guidelines for care
Example of Lack of Pediatric
EBM

Newborn Hearing Screening

Mission of the AAP

To attain optimal physical, mental, and

social health and well-being for all
infants, children, adolescents, and
young adults. To accomplish this
mission, the Academy shall support the
professional needs of its members.
AAP Organizational Structure

62,000 members
30 committees
50 sections
5 councils
66 chapters
Board of Directorselected from Districts
Districts of the AAP
Strategic Priorities of the AAP
2006-2007
AAP Approach to Policy

Policy Statements

Clinical Reports

Technical Reports

Clinical Practice Guidelines

Policy Transparency

The degree to which a policys purpose and

basis are clear to policy users.

Allows potential users to judge the

reasonableness of a policy by seeing how the
policy-makers arrived at the resulte.g.
published scientific evidence, pathophysiologic
reasoning, clinicians experiences, and
perceptions of societys and patients values.
Transparency

Increases the credibility of policy-making

groups.
Makes the process of policy formulation
clear to users.
Improves the clarity of recommendations
to facilitate implementation.
 Pediatric EBM Example of
Opportunities, Challenges and
Transparency

Bright Futures Guidelines