Pediatric Residents: EBM Review and Practice

Provides specialty based search examples for practicing the EBM steps related to asking clinical questions and acquiring evidence.

Patient Scenario

For a child/pediatric patient, is ibuprofen as effective as morphine during the post-operative/postfracture period?

PICOTT Analysis of the Clinical Question

Patient / Problem Child/Pediatric Patient, Postoperative/Postfracture Pain Management
Intervention Ibuprofen OR Non-Narcotic Analgesic
Comparison Morphine OR Opioid Analgesics
Outcome Safe and Effective Pain Management
Type of Question Therapy
Type of Study Systematic Review of RCTs > individual RCTs > cohort studies

PICOTT to Search

Select words from the PICOTT concepts to guide the development of a PubMed search. Remember:

  • Start with key concepts. You do not need to use all of the concepts or all the words.
  • Gender and specific age limits are usually added after a preliminary search unless they are central to the clinical question.
  • Consider alternate word endings, especially for key concepts.
  • Consider synonyms.
  • Use an OR to combine alternate word endings and enclose the set of similar words in parentheses.
Question Search Terms
Pediatric Patient aged 2-12 (child OR pediatric OR children)
  AND
postoperative/postfracture period

(fracture OR fractures OR surgery OR surgical OR surgical procedures, operative[mesh])

  AND
pain

(pain OR pain, postoperative[mesh] OR "pain management")

  AND
ibuprofen (ibuprofen OR analgesics, non-narcotic[mesh])
  AND
morphine (morphine OR analgesics, opioid[mesh])
  AND
Study design filters Systematic Review of RCTs > individual RCTs > cohort studies

 

Preliminary search:

(child OR pediatric OR children) AND (fracture OR fractures OR surgery OR surgical OR surgical procedures, operative[mesh]) AND (pain OR pain, postoperative[mesh] OR "pain management") AND (ibuprofen OR analgesics, non-narcotic[mesh]) AND (morphine OR analgesics, opioid[mesh])

 

Evaluate the Search

Run the search in PubMed:

  • On 05/08/2015, this search found 212 results, of which many looked relevant.
  • Are these results valid and useful?  Are there too many results?
  • It is usually a good idea to try several iterative searches before deciding on the final search strategy.

Check the Search Details:

(("child"[MeSH Terms] OR "child"[All Fields]) OR ("pediatrics"[MeSH Terms] OR "pediatrics"[All Fields] OR "pediatric"[All Fields]) OR ("child"[MeSH Terms] OR "child"[All Fields] OR "children"[All Fields])) AND (("fractures, bone"[MeSH Terms] OR ("fractures"[All Fields] AND "bone"[All Fields]) OR "bone fractures"[All Fields] OR "fracture"[All Fields]) OR ("fractures, bone"[MeSH Terms] OR ("fractures"[All Fields] AND "bone"[All Fields]) OR "bone fractures"[All Fields] OR "fractures"[All Fields]) OR ("surgery"[Subheading] OR "surgery"[All Fields] OR "surgical procedures, operative"[MeSH Terms] OR ("surgical"[All Fields] AND "procedures"[All Fields] AND "operative"[All Fields]) OR "operative surgical procedures"[All Fields] OR "surgery"[All Fields] OR "general surgery"[MeSH Terms] OR ("general"[All Fields] AND "surgery"[All Fields]) OR "general surgery"[All Fields]) OR ("surgical procedures, operative"[MeSH Terms] OR ("surgical"[All Fields] AND "procedures"[All Fields] AND "operative"[All Fields]) OR "operative surgical procedures"[All Fields] OR "surgical"[All Fields]) OR "surgical procedures, operative"[MeSH Terms]) AND (("pain"[MeSH Terms] OR "pain"[All Fields]) OR "pain, postoperative"[MeSH Terms] OR "pain management"[All Fields]) AND (("ibuprofen"[MeSH Terms] OR "ibuprofen"[All Fields]) OR "analgesics, non-narcotic"[MeSH Terms]) AND (("morphine"[MeSH Terms] OR "morphine"[All Fields]) OR "analgesics, opioid"[MeSH Terms])

  • Look for terms that did not map to a MeSH term, or did not map effectively to a MeSH Term.

Revise the Search:

This patient scenario is an example of a clinical question where there appears to be evidence that is specifically relevant and useful in order to make an informed decision.

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