Evidence-based medicine (EBM) in trauma surgery

Implementation of evidence-based medicine (EBM) in its actual sense - as an innovative way to improve individual patient care by synthesizing the best available external evidence (i.e., results of clinical research) and medical experience - into trauma surgery has not yet been adequately achieved. Besides reasons not pertaining to the field such as an overly theoretical and formal definition, the special features of surgical disciplines were not sufficiently taken into consideration by the originators of EBM. The significance of clinical trials is increasingly assessed based on hierarchically structured evidence levels. Meta-analysis of randomized studies and subsequently those analyses themselves represent the reference standard for therapeutic intervention trials. Verification of a causative relationship between intervention and results not only depends on the study design but also on recognized criteria for causality, the a priori probability, and the extent of the treatment effect observed. Trauma surgery exhibits specific differences from nonsurgical disciplines which need to be considered when choosing the study design and grading the evidence. The quality of the results is inseparably linked to surgical expertise.