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.
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.
Authors: Claire Keogh; Emma Wallace; Kirsty K O'Brien; Rose Galvin; Susan M Smith; Cliona Lewis; Anthony Cummins; Grainne Cousins; Borislav D Dimitrov; Tom Fahey Journal: Ann Fam Med Date: 2014-07 Impact factor: 5.166
Authors: Yvette van Ierland; Gijs Elshout; Marjolein Y Berger; Yvonne Vergouwe; Marcel de Wilde; Johan van der Lei; Henriëtte A Mol; Rianne Oostenbrink Journal: Br J Gen Pract Date: 2015-04 Impact factor: 5.386
Authors: Ruud G Nijman; Yvonne Vergouwe; Henriëtte A Moll; Frank J Smit; Floor Weerkamp; Ewout W Steyerberg; Johan van der Lei; Yolanda B de Rijke; Rianne Oostenbrink Journal: Pediatr Res Date: 2017-11-08 Impact factor: 3.756
Authors: Kathy Boutis; Paul Grootendorst; Andrew Willan; Amy C Plint; Paul Babyn; Robert J Brison; Arun Sayal; Melissa Parker; Natalie Mamen; Suzanne Schuh; Jeremy Grimshaw; David Johnson; Unni Narayanan Journal: CMAJ Date: 2013-08-12 Impact factor: 8.262