Poryo Martin, Khosrawikatoli Sara, Abdul-Khaliq Hashim, Meyer Sascha
Department of Pediatric Cardiology, Saarland University Hospital, Kirrberger Straße, 66421, Homburg/saar, Germany.
Medical School, University of Saarland, Homburg/saar, Germany.
Pediatr Cardiol. 2017 Apr;38(4):719-733. doi: 10.1007/s00246-017-1572-2. Epub 2017 Feb 27.
Evidence-based medicine has contributed substantially to the quality of medical care in pediatric and adult cardiology. However, our impression from the bedside is that a substantial number of Cochrane reviews generate inconclusive data that are of limited clinical benefit. We performed a systematic synopsis of Cochrane reviews published between 2001 and 2015 in the field of pediatric cardiology. Main outcome parameters were the number and percentage of conclusive, partly conclusive, and inconclusive reviews as well as their recommendations and their development over three a priori defined intervals. In total, 69 reviews were analyzed. Most of them examined preterm and term neonates (36.2%), whereas 33.3% included also non-pediatric patients. Leading topics were pharmacological issues (71.0%) followed by interventional (10.1%) and operative procedures (2.9%). The majority of reviews were inconclusive (42.9%), while 36.2% were conclusive and 21.7% partly conclusive. Although the number of published reviews increased during the three a priori defined time intervals, reviews with "no specific recommendations" remained stable while "recommendations in favor of an intervention" clearly increased. Main reasons for missing recommendations were insufficient data (n = 41) as well as an insufficient number of trials (n = 22) or poor study quality (n = 19). There is still need for high-quality research, which will likely yield a greater number of Cochrane reviews with conclusive results.
循证医学对儿科和成人心脏病学的医疗质量有重大贡献。然而，我们从临床床边观察的印象是，大量Cochrane综述得出的数据尚无定论，临床益处有限。我们对2001年至2015年间发表的儿科心脏病学领域的Cochrane综述进行了系统概述。主要结果参数包括定论性、部分定论性和非定论性综述的数量和百分比，以及它们的建议及其在三个预先定义的时间段内的发展情况。总共分析了69篇综述。其中大多数研究对象是早产和足月新生儿（36.2%），而33.3%的研究对象还包括非儿科患者。主要主题是药理学问题（71.0%），其次是介入性（10.1%）和手术操作（2.9%）。大多数综述尚无定论（42.9%），而定论性的占36.2%，部分定论性的占21.7%。尽管在三个预先定义的时间段内发表的综述数量有所增加，但“无具体建议”的综述保持稳定，而“支持某种干预措施的建议”明显增加。缺乏建议的主要原因是数据不足（n = 41）、试验数量不足（n = 22）或研究质量差（n = 19）。仍然需要高质量的研究，这可能会产生更多有定论结果的Cochrane综述。
