Department of Pediatrics, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
Pediatrics. 2011 Sep;128(3):e666-77. doi: 10.1542/peds.2011-0043. Epub 2011 Aug 22.
The degree to which clinical prediction rules (CPRs) for children meet published standards is unclear.
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.
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.
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.
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.
临床预测规则（CPR）在儿童中的应用程度尚不清楚。
系统地评价已发表的儿童 CPR 的质量、性能和验证情况，并与成人 CPR 进行比较，提出儿科 CPR 方法学的具体改进建议。
检索 Medline 1950 年至 2011 年的文献。纳入标准为：包含儿童（年龄＜18 岁）CPR 开发的研究。由 2 名评价者评估研究质量、规则性能和验证作为方法学标准。
共 7298 篇标题和摘要中，有 137 项符合纳入标准，共描述了 101 项针对 36 种儿科疾病的 CPR。仅有不足一半（47%）的研究符合盲法评估预测因素、（18%）预测因素的可重复性、（42%）结局的盲法评估、（36%）结局的充分随访、（43%）足够的效能、（49%）充分报告结果和（36%）报告 95%置信区间的标准。在规则性能方面，48%的敏感性＞0.95，43%的阴性似然比＜0.1。在规则验证方面，76%的研究未进行验证，17%的研究验证范围较窄，8%的研究验证范围较宽，没有研究进行影响分析。与成人 CPR 相比，儿童 CPR 的质量和验证似乎更低。
已有许多 CPR 应用于儿童，但仅有少数得到验证。与成人 CPR 相比，一些质量指标表现欠佳。对于涉及儿童的 CPR，现有的性能标准可能难以达到。更具辅助性而非指令性、纳入患者价值观和偏好的 CPR 可能有助于决策。
