An evaluation of Medline published paediatric audits from 1966 to 1999

Aim: To evaluate the quality of paediatric audits from 1966 to 1999. Methods: A Medline search was performed using the MeSH terms audit, child, paediatric (and pediatric). Predefined core elements of audit were used as inclusion criteria for entry of an article into this study. These criteria were as follows: (1) an article deals with a healthcare topic; (2) a standard is predefined; (3) actual practice is evaluated; (4) actual practice is compared with the standard. The fifth criterion of audit, dissemination of information and reaudit, was not an inclusion criterion, as it was not used in the early years covered by this study. Empirical grading of standards was used. Results: The search yielded 442 articles, of which 303 (100%) were related to paediatric healthcare and were reviewed. Standards were defined in 115 (38%) articles. Audit against the standard was performed in 92 (30.4%) articles, of which 42 (45.6%) were published before, and 50 (54.3%) after, 1990. 18 (5.9%) articles were re-audited: 6 (14.3%) were published before, and 12 (24%) after, 1990. Of the 188 paediatric studies rejected, 119 (63.3%) described practice observations. Conclusion: Many articles in paediatrics are published as "audits", but they do not contain the core elements of audit. Although audit is a potentially valuable tool in clinical medicine, the publication of poor-quality audits may lead to the decline of the audit concept. Suggestions on ways to improve the quality of published audits are made.