Influence of Single-Trial Results on Clinical Practice Example of Adenotonsillectomy in Children

Objective: To establish whether the results of a 2004 trial on the effectiveness of adenotonsillectomy in children with mild to moderate symptoms of throat infection or adenotonsillar hypertrophy affected physicians' beliefs about the benefits of the operation and influenced clinical practice. Design: Prospective prior-posterior study. Setting: Academic research. Participants: We evaluated beliefs prior and posterior to the 2004 trial regarding the benefits of adenotonsillectomy in a random sample of 120 Dutch otolaryngologists and 120 Dutch general practitioners. Main Outcome Measure: Physicians were asked to give their estimates of the probability of recovery during 1 year after adeno tonsillectomy or a nonsurgical strategy in 3 scenarios of children aged 3 to 4 years with recurrent throat infection, upper respiratory tract infection (with or without fever), or sleep-related breathing disorder. Results: Ninety-four percent of otolaryngologists (n=46) and 31% of general practitioners (n=14) were familiar with the 2004 trial results. Posterior beliefs of otolaryngologists and general practitioners did not differ substantially from prior beliefs; overall expectations regarding the benefits of adenotonsillectomy remained high. Conclusion: Dissemination of the 2004 trial results did not seem to affect the beliefs of physicians regarding the benefits of adenotonsillectomy.