Evidence-Based Medicine is at the Core of UpToDate

“Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”

Evidence based medicine: what it is and what it isn't. Sackett David L, Rosenberg William M C, Gray J A Muir, Haynes R Brian, Richardson W Scott. BMJ 1996; 312 :71

UpToDate has a systematic and transparent editorial policy for identifying, reviewing and synthesizing clinical evidence as it applies to a clinical question.

At the top of the evidence hierarchy are meta-analyses of randomized trials of high methodological quality, followed by randomized trials with methodological limitations, then observational studies and unsystematic clinical observations. Inferences are stronger when the evidence is summarized in systematic reviews that present all relevant data.

Our in-house physician deputy editors, all of whom receive training in clinical epidemiology, oversee the integrity and consistency of this process. We review evidence from:

  • More than 425 peer-reviewed journals
  • Society guidelines, clinical databases, and clinical trials for important new medical findings
  • Databases including Medline, The Cochrane Library, Clinical Evidence, and the Agency for Healthcare Research and Quality
  • Guidelines and trial reports from leading agencies like the U.S. Centers for Disease Control and Prevention, the European Medicines Agency, and the World Health Organization.
  • Proceedings of major national and international scientific meetings.

UpToDate excels at determining how evidence and best clinical practice can be applied to individual patients at the point of care.

More than 7,300 world-renowned experts with extensive patient care experience assist our editors in applying evidence to specific patient situations.

To create and update the clinical topics in UpToDate, our editorial staff performs comprehensive reviews of the medical literature and considers the quality of the study, the hierarchy of evidence, and its clinical relevance.

Unlike other evidence-based resources, UpToDate makes specific recommendations for patient care whenever possible. New evidence and recommendations are published every business day.

“… evidence alone is never sufficient to make a clinical decision. Decision makers must always trade off the benefits and risks, burden, and costs associated with alternative management strategies and, in doing so, consider their patients' unique predicament and values and preferences.”

Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, Third Edition. Gordon Guyatt, Drummond Rennie, Maureen O. Meade, Deborah J. Cook. JAMA Evidence. 2015.

Our recommendations are based on a synthesis of evidence, including that obtained from clinical trials as well as clinical experience. Their strength is continually evaluated based on the GRADE system. Dr. Gordon Guyatt, a cofounder of the system, provides regular training to our physician editors about evidence-based medicine and grading.