Karas Jacek, Ashkenazi Shai, Guarino Alfredo, Lo Vecchio Andrea, Shamir Raanan, Vandenplas Yvan, Szajewska Hania
Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland.
Schneider Children's Medical Center, Petach-Tikva, Israel Sackler Faculty of Medicine, Felsenstein Medical Research Center, Tel Aviv University, Tel Aviv, Israel.
Arch Dis Child. 2015 Apr;100(4):359-63. doi: 10.1136/archdischild-2014-307403. Epub 2014 Nov 20.
Core outcome sets are the baseline for what should be measured in clinical research and, thus, should serve as a guide for what should be collected and reported. The Consensus Group on Outcome Measures Made in Pediatric Enteral Nutrition Clinical Trials, established in 2012, agreed that consensus on a core set of outcomes with agreed-upon definitions that should be measured and reported in clinical trials was needed. To achieve this goal, six working groups (WGs) were setup, including WG on acute diarrhoea, whose main goal was to develop a core outcome set for trials in acute diarrhoea.
The first step identified how published outcomes related to acute diarrhoea were reported. The second focused on the methodology for determining which outcomes to measure in clinical trials. The third employed a two-phase questionnaire study using the Delphi technique to define clinically important outcomes to clinicians and parents.
For therapeutic studies, the five most important outcome measures were diarrhoea duration, degree of dehydration, need for hospitalisation (or duration of hospitalisation for inpatients), the proportion of patients recovered by 48 h and adverse effects. The prophylactic core outcome set included prevention of diarrhoea, prevention of dehydration, prevention of hospitalisation and adverse effects.
The outcome sets for therapy and prevention can be recommended for use in future trials of patients with gastroenteritis. Their envisioned goal is to decrease study heterogeneity and to ease the comparability of studies. WG's next step is to determine how to measure the outcomes included in the core set.
核心结局集是临床研究中应测量内容的基线,因此应作为指导收集和报告内容的依据。2012年成立的儿科肠内营养临床试验结局指标共识小组一致认为,需要就临床试验中应测量和报告的一组具有商定定义的核心结局达成共识。为实现这一目标,设立了六个工作组(WG),包括急性腹泻工作组,其主要目标是制定急性腹泻试验的核心结局集。
第一步确定已发表的与急性腹泻相关的结局是如何报告的。第二步重点关注确定临床试验中应测量哪些结局的方法。第三步采用两阶段问卷调查研究,运用德尔菲技术向临床医生和家长定义对他们而言具有临床重要性的结局。
对于治疗性研究,五个最重要的结局指标是腹泻持续时间、脱水程度、住院需求(或住院患者的住院时间)、48小时内康复患者的比例以及不良反应。预防性核心结局集包括预防腹泻、预防脱水、预防住院和不良反应。
治疗和预防的结局集可推荐用于未来的肠胃炎患者试验。其预期目标是减少研究的异质性并便于研究之间的可比性。工作组的下一步是确定如何测量核心集中包含的结局。