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Background: The Pediatric Orthopaedic Society of North America (POSNA) is a leading organization focused on disseminating research and promoting high-quality pediatric orthopaedic care. The purpose of our study was to understand how research quality in pediatric orthopaedic surgery has evolved over time by evaluating trends in clinical evidence and study design in podium presentations given at POSNA annual meetings from 2011-2020.
Methods: Podium presentation abstracts for all POSNA meetings from 2011-2020 were independently reviewed for number of study patients, single-center versus multicenter, randomized vs. non-randomized design, and abstract focus/topic. The level of evidence (LOE) assigned in the abstract program was also recorded. Chi-squared and Mann-Whitney U tests were used to compare differences in abstract characteristics between 2011-2015 and 2016-2020. Linear regressions were performed to analyze changes in level of evidence and the proportion of multicenter studies over time.
Results: A total of 1589 podium presentations were reviewed including 679 from 2011-2015 and 910 from 2016-2020, representing a 34% increase in the total number of presentations. The median number of patients per abstract was higher in 2016-2020 compared to 2011-2015 (81.5 vs. 49, p<0.001). An increased proportion of presentations from 2016-2020 were multicenter (14.1% vs. 9.7%, p=0.009), with spine abstracts having the highest proportion of multicenter collaboration (23.9%, p=0.002). More studies from 2011-2015 focused on spine (19.5% vs. 14.9%, p=0.018). Overall, 4.9% of the presentations were categorized as Level 1 evidence, 18.5% level 2, 41.8% level 3, and 34.8% level 4. Between 2011-2020, the proportion of LOE 3 studies increased (p=0.039) and the proportion of LOE 4 studies approached a significant decrease (p=0.060). There was no change in the proportion of level 1 and 2 studies (p=0.416).
Conclusions: POSNA podium presentations have increased in number over the past decade, in large part due to the development of subspecialty day programs. This appears to have resulted in greater diversity in the academic program, with a lower proportion of spine abstracts over time. The LOE of POSNA presentations has increased with a higher proportion of level 3 and a lower proportion of level 4 evidence studies. More recent abstracts have evaluated higher numbers of patients and more commonly utilized multicenter study designs, suggesting improved collaboration.