Methodological Quality of Pediatric Clinical Prediction Rules

Abstract

Clinical prediction rules (CPRs) are tools designed to assist medical decision making and derived from an original piece of research. CPRs are intended for the use of clinicians when caring for patients to help them to make diagnostic and/or therapeutic bedside decisions. CPRs have been developed in the field of pediatrics since the 1990s, and we aimed to review and compare pediatric CPRs methodological quality to the one of adult CPRs. We manually searched for pediatric CPRs in the main general and pediatric journals published during one year. We assessed the quality of study with methodological standards and compared it to adult CPRs quality. Of 2126 titles screened, 12 CPRs were included. Pediatric CPRs fulfilled most of the quality items, except outcome blindness assessment, inter-observer reproducibility evaluation and a priori sample size calculation. Comparison with adult CPRs methodological quality did not show any statistical significance, except again for blindness assessment, study site description and course of action more often provided in pediatric CPRs than in adult CPRs. High-performing rigorously derived and well-validated CPRs have the potential for improving child health outcomes and limiting resource use. Improvement of identified drawbacks in CPRs derivation may favor their development and implementation in clinical practice. Attempting to incorporate parents’, patients’ and clinicians’ values and preferences in the decision-making process may also be considered for the coming CPRs derivation. Another challenge for the coming years will be to move forward integrating ‘omics’ revolution into CPRs derivation keeping in mind the realities of clinical pediatric practice.