Focus on identifying and closing knowledge gaps in acute appendicitis

Excerpt

Surgical science that informs patient care has evolved along two principal pathways: retrospective review of what has already occurred, and trials that test interventions designed to improve outcomes. The current environment of evidence-based practice favors rigorous investigations such as the prospective, randomized and controlled trial. These studies are tightly focused and intensely investigate only patients who fulfill entry criteria. As valuable as those investigations are in advancing science and patient care, they may not reflect the breadth of current practice that includes patients with characteristics that would prevent inclusion in a prospective randomized controlled trial (RCT). Indeed, for any given surgical condition, there are broad variations in approaches to care, delivery methods and outcomes that merit investigation. These variations are important to recognize and explore as they may disclose the question that a prospective RCT is ideally suited to answer. This special issue of the European Journal of Trauma and Emergency Surgery is devoted to a method of inquiry that bridges the gap between retrospective database review and RCT—the snapshot audit. …