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J Clin Monit Comput · Aug 2017
ReviewCommentary : The value of intraoperative neurophysiological monitoring: evidence, equipoise and outcomes.
- R N Holdefer and S A Skinner.
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Box 359740, Seattle, WA, 98104-2499, USA.
- J Clin Monit Comput. 2017 Aug 1; 31 (4): 657-664.
AbstractThe use of intraoperative neurophysiological monitoring (IONM) has grown despite an absence of randomized controlled trials that might unequivocally demonstrate improved outcomes. At issue is how to demonstrate value when other evidence indicates patient harms (opportunity cost) if IONM is withheld for the sake of randomization. In this article we review other non-randomized methods to assess the effects of IONM on post-operative outcomes. We also examine how clinical equipoise may resolve whether (or not) an anticipated controlled study is ethical. We conclude that the value of IONM in a particular surgical setting should be determined by a benefits/harms analysis based on all the available evidence.
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