Evidence Base for Oral and Maxillofacial Surgery Journals

An interesting articled titled “The evidence base for oral and maxillofacial surgery: 10-year analysis of two journals,” appeared in the January 2012 edition of the British Journal of Oral and Maxillofacial Surgery (vol. 50, issue 1, pages 45-48) wirrten by Amandip Sandhu.

The author opens by discussing an editorial in the Lancet in 1996 which discussed how there is a lack of scientific rigor in surgical research.

The author states

“There is a well established hierarchy of levels of evidence, and the medical community considers that meta-analyses and randomised controlled trials (RCTs) are the most scientifically stringent means of investigating the efficacy of one intervention against another. Other grades of evidence (in increasing weakness of level of evidence) are case controlled studies, comparative studies, case series, correlation studies and expert committee reports, and the clinical experiences of respected authorities.”

The author evaluated articles published in both the British Journal of Oral and Maxillofacial Surgery and the International Journal of
Oral and Maxillofacial Surgery between January 1999 and December 2009. The author looked at the abstract of every article and looked at the article in full if the abstract was not sufficient for analysis.

The author looked at 3294 articles and 1 meta-analysis and 68 randomized controlled trials (2%) were present.

The author points out how if one recommends involvement in a randomized controlled trial there must be a uncertainty about the benefit or harm from the intervention. Further using sham surgery as a control has issues.

The author briefly mentions the National Institute for Health and Clinical Excellence (NICE) and a brief discussion of the Cochrane Collaboration is made in which the author states that reviews relevant to oral and maxillofacial surgery consists of weak evidence.

The author than goes on to discuss the Impact Factor and how it should be interpreted with care.

The author states

“The latest [impact factors] IFs for the International Journal and the British Journal (2009) are 1.444 (2008: 1.487), and 1.327 (2008: 0.787), respectively. For comparison, the five medical journals in 2009 with the highest IFs were the New England Journal of Medicine (IF 50.017), the Journal of the American Medical Association (IF 31.171), The Lancet (IF 28.409), Annals of Internal Medicine (IF 17.457), and the British Medical Journal (IF 12.827).”

The author ends by saying

“Although the number of RCTs is comparable with other related specialties, in common with other surgical disciplines more effort is required to carry out better quality, ethical research if we are to provide patients with the best possible evidence for our interventions, given the recognised difficulties in carrying out such research.”

A table with the results of the analysis is presented in the article. A total of 618 of the 1715 (36%) BJOMS articles reviewed and 481 of the 1579 (31%) of the IJOMS articles reviewed consisted of case series which were by far the highest type of papers in the journals.