Key result
Pediatric clinical prediction rules demonstrated similar methodological quality to adult rules for most items, but utilized blinded outcome assessment significantly less often (8% vs 41%, p=0.04).
Why the study?
How does the methodological quality of pediatric clinical prediction rules compare to that of adult clinical prediction rules?
How does the methodological quality of pediatric clinical prediction rules compare to that of adult clinical prediction rules?
Absolute Event Rate: 8% vs 41%
p-value: p=0.04
Pediatric clinical prediction rules demonstrate similar methodological quality to adult rules, though they frequently lack outcome blindness assessment, inter-observer reproducibility evaluation, and a priori sample size calculation.
Pediatric rules risk outcome bias from infrequent blinding; challenges equivalence to adult rules and urges improved methodology in future studies.
Clinical prediction rules (CPRs) are tools designed to assist medical decision making and derived from an original piece of research. CPRs are intended for the use of clinicians when caring for patients to help them to make diagnostic and/or therapeutic bedside decisions. CPRs have been developed in the field of pediatrics since the 1990s, and we aimed to review and compare pediatric CPRs methodological quality to the one of adult CPRs. We manually searched for pediatric CPRs in the main general and pediatric journals published during one year. We assessed the quality of study with methodological standards and compared it to adult CPRs quality. Of 2126 titles screened, 12 CPRs were included. Pediatric CPRs fulfilled most of the quality items, except outcome blindness assessment, inter-observer reproducibility evaluation and a priori sample size calculation. Comparison with adult CPRs methodological quality did not show any statistical significance, except again for blindness assessment, study site description and course of action more often provided in pediatric CPRs than in adult CPRs. High-performing rigorously derived and well-validated CPRs have the potential for improving child health outcomes and limiting resource use. Improvement of identified drawbacks in CPRs derivation may favor their development and implementation in clinical practice. Attempting to incorporate parents', patients' and clinicians' values and preferences in the decision-making process may also be considered for the coming CPRs derivation. Another challenge for the coming years will be to move forward integrating 'omics' revolution into CPRs derivation keeping in mind the realities of clinical pediatric practice.
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Sandrine Leroy (2014) conducted a review in Pediatric Clinical Prediction Rules (n=12). Pediatric clinical prediction rules vs. Adult clinical prediction rules was evaluated on Blind assessment of outcome (p=0.04). Pediatric clinical prediction rules demonstrated similar methodological quality to adult rules for most items, but utilized blinded outcome assessment significantly less often (8% vs 41%, p=0.04).
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