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The Benefits and Harms of Endoscopy and Other Diagnostic Tests to Detect Underlying Conditions in Children With
Ibrahim K El Mikati1, Nadia I Ibrahimi2, Abrar Alshorman1
1Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas.
Insights
Diagnostic tests for faltering weight in young children have uncertain benefits and harms. Clinicians should use discretion, considering individual patient factors and potential risks before testing.
Area of Science:
- Pediatrics
- Gastroenterology
- Diagnostic Medicine
Background:
- Faltering weight, previously termed "failure to thrive," presents with poor weight gain and diverse etiologies requiring specific diagnostic approaches.
- This technical report focuses on children under five years old residing in high-income nations.
Purpose of the Study:
- To systematically review the benefits and harms of diagnostic tests, including endoscopy, for faltering weight in young children.
- To evaluate the evidence base for diagnostic accuracy and procedural complications associated with these tests.
Main Methods:
- Conducted two systematic reviews of electronic databases (PubMed, Embase, CINAHL, Cochrane Library) up to September 27, 2022.
- Employed independent, duplicate screening of extracted data and assessed evidence certainty using the Grading of Recommendations, Assessments, Development, and Evaluation (GRADE) approach.
Main Results:
- Six studies reported on the benefits/harms of general diagnostic tests, with two discussing test accuracy and prevalence of underlying conditions.
- Nine studies examined endoscopy, detailing diagnostic findings, histological results, and procedural complications.
- The certainty of the evidence was rated as very low due to significant concerns regarding risk of bias, inconsistency, and indirectness.
Conclusions:
- Diagnostic testing for faltering weight in children should be guided by clinician discretion, patient condition, and careful consideration of potential harms and costs.
- Further research is essential to better define the benefits and harms of diagnostic evaluations for faltering weight in young children.
Background And Objective:
Faltering weight (previously known as "failure to thrive") is a condition characterized by poor weight gain and has varied underlying etiologies that may require distinct diagnostic evaluations. This technical report describes systematic reviews to identify the benefits and harms of diagnostic tests, including endoscopy, in children younger than 5 years who live in high-income countries.
Methods:
Two systematic reviews were conducted to assess the evidence regarding benefits and harms of diagnostic tests (including endoscopy) in these children. The search was conducted in electronic databases PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Library up to September 27, 2022. Two review team members screened extracted data from potentially eligible articles independently and in duplicate. The Grading of Recommendations, Assessments, Development, and Evaluation (GRADE) approach was used to assess the certainty (eg, quality) of evidence.
Results:
Six studies met inclusion criteria for the benefits and harms of a subset of diagnostic tests. The studies reported on the prevalence of underlying conditions; 2 of these studies also discussed test accuracy. Nine studies met inclusion criteria for evidence on the benefits and harms of endoscopy as a diagnostic tool. Seven studies discussed endoscopic diagnosis, 2 studies discussed histological findings, and 1 discussed procedural complications. The certainty in the evidence was very low because of concerns with risk of bias, inconsistency, and indirectness.
Conclusions:
Diagnostic testing for underlying conditions in children who are suspected of having faltering weight should be performed at the clinician's discretion, on the basis of the child's condition, while considering tests' potential harms and costs. Future research is needed to better characterize the benefits and harms of evaluations in young children who are being assessed for faltering weight.
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