Children in reviews: methodological issues in child-relevant evidence syntheses.
BACKGROUND
The delivery of optimal medical care to children is dependent on the availability of child relevant research. Our objectives were to: i) systematically review and describe how children are handled in reviews of drug interventions published in the Cochrane Database of Systematic Reviews (CDSR); and ii) determine when effect sizes for the same drug interventions differ between children and adults.


METHODS
We systematically identified all of the reviews relevant to child health in the CDSR 2002, Issue 4. Reviews were included if they investigated the efficacy or effectiveness of a drug intervention for a condition that occurs in both children and adults. Information was extracted on review characteristics including study methods, results, and conclusions.


RESULTS
From 1496 systematic reviews, 408 (27%) were identified as relevant to both adult and child health; 52% (213) of these included data from children. No significant differences were found in effect sizes between adults and children for any of the drug interventions or conditions investigated. However, all of the comparisons lacked the power to detect a clinically significant difference and wide confidence intervals suggest important differences cannot be excluded. A large amount of data was unavailable due to inadequate reporting at the trial and systematic review level.


CONCLUSIONS
Overall, the findings of this study indicate there is a paucity of child-relevant and specific evidence generated from evidence syntheses of drug interventions. The results indicate a need for a higher standard of reporting for participant populations in studies of drug interventions.
Cramer
Kristie
K
Alberta Research Centre for Child Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. kcramer@ualberta.ca
Wiebe
Natasha
N
Moyer
Virginia
V
Hartling
Lisa
L
Williams
Katrina
K
Swingler
George
G
Klassen
Terry P
TP
D000293:Adolescent; D035843:Biomedical Research / Q000379:methods* / Q000592:standards; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D004358:Drug Therapy / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015201:Meta-Analysis as Topic; D010372:Pediatrics; D012107:Research Design; D012196:Review Literature as Topic; D016896:Treatment Outcome