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Clinical prediction rules for children: a systematic review.
Jonathon L Maguire1, Dina M Kulik, Andreas Laupacis
1Department of Pediatrics, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada. jonathon.maguire@utoronto.ca
Pediatrics
|August 24, 2011
Summary
Clinical prediction rules (CPRs) for children often lack validation and quality compared to adult CPRs. Pediatric CPRs need improvement to better assist decision-making, incorporating patient values.
Area of Science:
- Pediatric medicine
- Clinical epidemiology
- Health informatics
Background:
- Published clinical prediction rules (CPRs) for pediatric populations have unclear adherence to established quality standards.
- The methodological rigor of CPRs developed for children requires systematic evaluation.
Purpose of the Study:
- To systematically review the quality, performance, and validation of pediatric CPRs.
- To compare pediatric CPRs with those developed for adult conditions.
- To propose pediatric-specific enhancements to CPR development methodology.
Main Methods:
- A comprehensive literature search of Medline from 1950 to 2011 was conducted.
- Studies involving the development of CPRs for individuals under 18 years were included.
- Two independent investigators assessed study quality, rule performance, and validation against predefined methodologic standards.
Main Results:
- 101 CPRs for 36 pediatric conditions were identified from 137 eligible studies.
- Fewer than half of the studies met quality standards for predictor assessment, reproducibility, outcome assessment, follow-up, statistical power, and result reporting.
- A significant majority of pediatric CPRs lacked external validation (76%) or impact analysis (100%), with lower quality indicators compared to adult CPRs.
Conclusions:
- While many CPRs exist for children, robust validation is infrequent.
- Pediatric CPRs exhibit weaknesses in quality and validation when compared to adult CPRs.
- Future pediatric CPRs should be more supportive, less prescriptive, and integrate patient values into clinical decision-making.
