Comparative effectiveness of medical interventions in adults versus children.
J Pediatr
; 157(2): 322-330.e17, 2010 Aug.
Article
em En
| MEDLINE
| ID: mdl-20434730
OBJECTIVE: To estimate the comparative effectiveness of medical interventions in adults versus children. STUDY DESIGN: We identified from the Cochrane Database of Systematic Reviews (Issue 1, 2007) meta-analyses with data on at least 1 adult and 1 pediatric randomized trial with binary primary efficacy outcome. For each meta-analysis, we calculated the summary odds ratio of the adult trials and the pediatric trials, respectively; the relative odds ratio (ROR) of the adult versus pediatric odds ratios per meta-analysis; and the summary ROR across all meta-analyses. ROR <1 means that the experimental intervention is more unfavorable in children than adults. RESULTS: Across 128 eligible meta-analyses (1051 adult and 343 pediatric trials), the summary ROR did not show a statistically significant difference between adults and children (0.96; 95% confidence intervals, 0.86 to 1.08). However, in all meta-analyses except for 1, the individual ROR's 95% confidence intervals could not exclude a relative difference in efficacy over 20%. In two-thirds, the relative difference in observed point estimates exceeded 50%. Nine statistically significant discrepancies were identified; 4 of them were also clinically important. CONCLUSIONS: Treatment effects are on average similar in adults and children, but available evidence leaves large uncertainty about their relative efficacy. Clinically important discrepancies may occur.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Serviços de Saúde
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Prognostic_studies
/
Systematic_reviews
Aspecto:
Determinantes_sociais_saude
Limite:
Adult
/
Child
/
Humans
Idioma:
En
Revista:
J Pediatr
Ano de publicação:
2010
Tipo de documento:
Article
País de afiliação:
Grécia
País de publicação:
Estados Unidos