Related Experiment Video
Updated: May 30, 2026
Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack
Published on: May 15, 2020
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
Insights
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.
Context:
The degree to which clinical prediction rules (CPRs) for children meet published standards is unclear.
Objective:
To systematically review the quality, performance, and validation of published CPRs for children, compare them with adult CPRs, and suggest pediatric-specific changes to CPR methodology.
Methods:
Medline was searched from 1950 to 2011. Studies were selected if they included the development of a CPR involving children younger than 18 years. Two investigators assessed study quality, rule performance, and rule validation as methodologic standards.
Results:
Of 7298 titles and abstracts assessed, 137 eligible studies were identified. They describe the development of 101 CPRs addressing 36 pediatric conditions. Quality standards met in fewer than half of the studies were blind assessment of predictors (47%), reproducibility of predictors (18%), blind assessment of outcomes (42%), adequate follow-up of outcomes (36%), adequate power (43%), adequate reporting of results (49%), and 95% confidence intervals reported (36%). For rule performance, 48% had a sensitivity greater than 0.95, and 43% had a negative likelihood ratio less than 0.1. For rule validation, 76% had no validation, 17% had narrow validation, 8% had broad validation, and none had impact analysis performed. Compared with CPRs for adult health conditions, quality and rule validation seem to be lower.
Conclusions:
Many CPRs have been derived for children, but few have been validated. Relative to adult CPRs, several quality indicators demonstrated weaknesses. Existing performance standards may prove elusive for CPRs that involve children. CPRs for children that are more assistive and less directive and include patients' values and preferences in decision-making may be helpful.
