Our Unrequited Love for Simple Explanation

Abstract

In the complex and often perplexing field of perinatology, it is often tempting to extrapolate the results of the latest published study to our daily clinical practice, especially when the study appears to provide simple answers to difficult questions. This tendency is further encouraged by sensational media coverage and commentaries that, by necessity, further simplify the issues and hype the speculation. Without a critical appraisal of the study population, methodology, analysis and conclusions stated, globalizing a single study's results to anyone's clinical practice can be well-intentioned but misguided. As an example, approximately 1 year ago the results of an NICHD study involving home uterine activity monitoring (HUAM) were released. The study concluded that, while the likelihood of preterm delivery increased with an increased baseline frequency of uterine contractions, measurement of this contractility was not a clinically efficient predictor of preterm delivery. Through the media and editorials that followed, the study results became translated so as to indicate that HUAM was not effective in preventing preterm delivery or improving perinatal outcomes. In our desire for a simple and definitive conclusion on HUAM, key facts about this study were forgotten. In the NICHD study, uterine contraction data were blinded to both physician and patient, and only intermittent preterm monitoring was used with no provision for emergency monitoring; a study design that guaranteed patient management and outcomes would not be affected by HUAM. Using the NICHD HUAM study as an example to be learned from, we should be more critical and independent in our appraisal of published trials. Evidence-based medicine is only useful when we pay as much attention to the methodology as we do to the results.