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Open Access Research article

Children in reviews: Methodological issues in child-relevant evidence syntheses

Kristie Cramer1*, Natasha Wiebe2, Virginia Moyer3, Lisa Hartling1, Katrina Williams4, George Swingler5 and Terry P Klassen1

Author Affiliations

1 Alberta Research Centre for Child Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada

2 Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada

3 Center for Population and Evidence Based Medicine, University of Texas-Houston Health Sciences Center, Houston, Texas, USA

4 Department of Pediatrics and Child Health, The Children's Hospital at Westmead, Westmead, New South Wales, Australia

5 School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa

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BMC Pediatrics 2005, 5:38  doi:10.1186/1471-2431-5-38

Published: 21 September 2005

Abstract

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.

Conclusion

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.