A Revised Evidence Pyramid for Veterinary Clinical Resources

Suzanne Fricke, DVM, MLIS

Animal Health Librarian, Washington State University

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Veterinary medicine is a field traditionally dependent on textbooks and expert opinion, often in the form of conference proceedings and monitored discussion boards, for clinical decision support. As electronic health record systems evolve with potential to bring more current research to the point of care, interest in evidence-based medicine grows. Evidence-based veterinary medicine (EBVM) integrates the best available research with clinical expertise, patient circumstances, and client values. Teaching of EBVM often relies on a hierarchical pyramid to visually represent studies in terms of their level of evidence. Though considered the highest level of evidence in the original 4S evidence pyramid, systematic reviews, and the randomized controlled trial studies on which they are based, are limited in veterinary medicine. In this imperfect information infrastructure, emerging veterinary resources, found in various forms such as critically appraised topics and clinical guidelines, seek to apply current best evidence to everyday clinical problems. Where do these new resources fit in terms of their level of evidence? While the human medical evidence pyramid was revised to a 5S or 6S model (Haynes 2006, Dicenso 2009) to incorporate newer synopses and summaries, current evidence hierarchies in veterinary medicine are still based on the 4S model. This project reviews current evidence hierarchies and newly emerging veterinary medical evidence resources for placement in a 6S hierarchy model. The revised pyramid provides an educational framework for veterinarians and veterinary students tasked with supporting clinical decisions with evidence in an evolving information environment. This model assumes a best case scenario and cautions that resources must be individually evaluated for quality.


evidence-based veterinary/methods, evidence hierarchy, evidence pyramid, decision support techniques

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