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The Level of Evidence Presented at Plastic Surgery Meetings: What do we have to learn?
Jennifer E. Chuback, MD1, Talia Varley, BSc.1, Blake Yarascavitch, MD1, Felmont Eaves, III, MD2, Mohit Bhandari, MD, PhD1, Achilles Thoma, MD, MSc1.
1McMaster University, Hamilton, ON, Canada, 2University of North Carolina, Charlotte, NC, USA.

ABSTRACT:
Purpose:
Recently plastic surgery societies have placed an increasing emphasis on the importance Evidence -Based Medicine (EBM). While Level of Evidence (LOE) grading has become commonplace in the literature, little is known about the level of evidence presented at annual meetings. Unlike submissions to many major journals, applicants and presenters are not required to determine or disclose the level of evidence of the research they present. Such meetings are a platform to disseminate advances from clinical research, serve as major learning opportunity for society members, and be used as an accredited Continuing Medical Education (CME) event to maintain accreditation and licensure. We aimed to categorize LOE presented at three major North American plastic surgical meetings.
Methods:
Presentations at the 2010/2011 meetings of the three largest national societies of plastic surgeons in North America were reviewed. Eligible studies were clinical scientific presentations (human studies including case reports, case series, case-control studies, cohort studies, randomized trials and meta-analyses), presented at the 2010/2011 meetings of the American Society of Plastic Surgeons (ASPS), the American Association of Plastic Surgeons (AAPS), and the Canadian Society of Plastic Surgeons (CSPS) in the English language. These were evaluated by two independent reviewers who attended the oral presentations meeting, area of research, number and origin of authors, area, centers of collaboration, number of subjects, study sub-type, and LOE. Data from all three meetings were pooled to conduct regression analysis to determine characteristics associated with higher Level studies (level I and II) compared to lower Level studies (III, IV, and V). All tests were two tailed and we considered p<0.05 the conventional level of statistical significance.
Results:
One hundred and eighty eight podium presentations were screened, and 126 met eligibility criteria. The ASPS was the largest meeting with 74 (58.7%). Presentations focused on breast (23.8%) and craniofacial (21.4%) were most frequently made. Presentations had a mean of 4.25 authors and a mean of 1.11
contributing centers. The majority of studies were prognostic (89.7%), with a sample size of 50 or fewer subjects (36.8%). Of these 126 podium presentations, 2 (1.6%) were Level I, 11 (8.7%) were Level II, 54 (42.9%) were Level III, 46 (36.5%) were Level IV, and 13 (10.3%) were Level V. There was no significant difference between the mean levels of evidence presented at the three meetings (p=0.09). The Podium presentations submitted that had multiple centres of collaboration as their data sources were associated with a higher level of evidence (χ2(1)=4.53, p=0.03).
Conclusions:
Level I evidence is the least represented at plastic surgical meetings. There is a need for higher LOE podium presentations. The challenge for the societies is to expect clinical researchers to present more randomized controlled trials, or Level II studies at annual societal meetings. This could be promoted through mandatory reporting of LOE grades during presentations at the plastic surgical meetings.


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