Clinical prediction rules for children: A systematic review

Jonathon L. Maguire, Dina M. Kulik, Andreas Laupacis, Nathan Kuppermann, Elizabeth M. Uleryk, Patricia C. Parkin

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalPediatrics
Volume128
Issue number3
DOIs
StatePublished - Sep 2011

Fingerprint

Decision Support Techniques
Pediatrics
Patient Preference
Decision Making
Research Personnel
Outcome Assessment (Health Care)
Confidence Intervals

Keywords

  • Adolescent
  • Child
  • Clinical prediction rule
  • Decision trees
  • Models
  • Multivariate analysis
  • Predictive value of tests
  • Preschool child
  • Review

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Maguire, J. L., Kulik, D. M., Laupacis, A., Kuppermann, N., Uleryk, E. M., & Parkin, P. C. (2011). Clinical prediction rules for children: A systematic review. Pediatrics, 128(3). https://doi.org/10.1542/peds.2011-0043

Clinical prediction rules for children : A systematic review. / Maguire, Jonathon L.; Kulik, Dina M.; Laupacis, Andreas; Kuppermann, Nathan; Uleryk, Elizabeth M.; Parkin, Patricia C.

In: Pediatrics, Vol. 128, No. 3, 09.2011.

Research output: Contribution to journalArticle

Maguire, JL, Kulik, DM, Laupacis, A, Kuppermann, N, Uleryk, EM & Parkin, PC 2011, 'Clinical prediction rules for children: A systematic review', Pediatrics, vol. 128, no. 3. https://doi.org/10.1542/peds.2011-0043
Maguire, Jonathon L. ; Kulik, Dina M. ; Laupacis, Andreas ; Kuppermann, Nathan ; Uleryk, Elizabeth M. ; Parkin, Patricia C. / Clinical prediction rules for children : A systematic review. In: Pediatrics. 2011 ; Vol. 128, No. 3.
@article{ed0e91faf03b40b9b017c7fa42da1981,
title = "Clinical prediction rules for children: A systematic review",
abstract = "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.",
keywords = "Adolescent, Child, Clinical prediction rule, Decision trees, Models, Multivariate analysis, Predictive value of tests, Preschool child, Review",
author = "Maguire, {Jonathon L.} and Kulik, {Dina M.} and Andreas Laupacis and Nathan Kuppermann and Uleryk, {Elizabeth M.} and Parkin, {Patricia C.}",
year = "2011",
month = "9",
doi = "10.1542/peds.2011-0043",
language = "English (US)",
volume = "128",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "3",

}

TY - JOUR

T1 - Clinical prediction rules for children

T2 - A systematic review

AU - Maguire, Jonathon L.

AU - Kulik, Dina M.

AU - Laupacis, Andreas

AU - Kuppermann, Nathan

AU - Uleryk, Elizabeth M.

AU - Parkin, Patricia C.

PY - 2011/9

Y1 - 2011/9

N2 - 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.

AB - 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.

KW - Adolescent

KW - Child

KW - Clinical prediction rule

KW - Decision trees

KW - Models

KW - Multivariate analysis

KW - Predictive value of tests

KW - Preschool child

KW - Review

UR - http://www.scopus.com/inward/record.url?scp=80052367660&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80052367660&partnerID=8YFLogxK

U2 - 10.1542/peds.2011-0043

DO - 10.1542/peds.2011-0043

M3 - Article

C2 - 21859912

AN - SCOPUS:80052367660

VL - 128

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 3

ER -