Writing an Evidence-Based Articles in Plastic Surgery Field

Many beginning writers, especially medical residents, feel difficulties in writing journal articles. However, illogical and un-scientific papers are not accepted for publication even if their topics are creative and interesting. The authors should do their best to convince reviewers and readers of their opinions using evidence through reasoning, explanation, and data interpretation. The aim of this article is to review evidence-based medicine (EBM) and reporting guidelines and to assist authors in composing plastic surgery papers with a logical argument. The concept of EBM was initially suggested in 1979 by Ar-chie Cochrane, who was a British epidemiologist. Since then, the trend of modern medicine has been toward completely evidence-based decision making [1]. Recently, the American Society of Plastic Surgeons (ASPS) and the journal Plastic and Reconstructive Surgery (PRS) have been actively working to build a foundation for EBM in the plastic surgery field [2]. In August 2010, various plastic surgery researchers and journal editors had a conference in Colorado Springs, US for the integration of EBM into the field of plastic surgery. At the conference , it was decided that the level of evidence and a visual icon of the evidence pyramid would be displayed at the end of the abstract of every article, except some that could not be rated, with classification of the research into one of these categories: diagnostic, therapeutic, prognostic, and risk. This decision has been in effect in PRS since January 1, 2011 [3]. Among the evidence levels assigned in PRS, level 1 represents the highest or strongest level of evidence, while level 5 is the lowest. The types of studies in level 3 include retrospective cohort studies and case control studies. The case series is included in level 4 [4]. The average level of plastic surgery articles submitted to PRS is 3.2 and most are between 3 and 4. The reasons for the relatively low levels in the field of plastic surgery are that each patient has highly variable requirements and some cases are rare due to the nature of plastic surgery, and there are diverse approaches to treating a given diagnosis [5]. To overcome these limitations, PRS estimate the level of evidence on all articles according to subsections. And PRS recommends that researchers aim to produce prospective cohort studies, which are in level 2, and eventually even level 1, randomized controlled studies, even though researchers typically start out by publishing level 3, 4, or …