Evidence made actionable

When you’re treating a patient, you want to make decisions based on the best available evidence and expertise. But even the most experienced clinicians need support in keeping up with new research and advances in care.

UpToDate authors and editors synthesize the available clinical evidence and best clinical practices to help you provide high quality care to your patients and high standards of research.

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

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.

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

 What is evidence-based medicine?
“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

Our in-house physician deputy editors, all of whom receive training in clinical epidemiology, oversee the integrity and consistency of this review process and work closely with the expert authors. 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 scientific meetings
  • More than 7,300 world-renowned experts with extensive clinical experience assist our editors in applying evidence to specific patient situations.

Graded recommendations allow you to make decisions even when evidence is not clear.

Our recommendations are based on a synthesis of evidence, including that obtained from clinical trials as well as clinical experience. The recommendations are categorized based on the GRADE system, which communicates the strength of the recommendation (strong or weak), and the quality of the evidence on which it is based (high, medium, or low). Gordon Guyatt, MD, a cofounder of the system, provides regular training to our physician editors about evidence-based medicine and grading.

“… 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.

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A pediatric resident uses UpToDate to diagnose a rare case of diabetes mellitus
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