Quality of evidence gap between adult and paediatric guidelines

Session: 

Oral session: Priority setting (2)

Date: 

Sunday 16 September 2018 - 17:10 to 17:20

Location: 

Carrick 3

All authors in correct order:

Cuello-García C1, Begum H1, Vesely S2, Monagle P3
1 McMaster University, Canada
2 University of Oklahoma, United States
3 Royal Children's Hospital of Melbourne, Australia
Presenting author and contact person

Presenting author:

Carlos Cuello-García

Contact person:

Carlos Cuello-García
Abstract text
Background: There is a paucity of evidence for many child-health topics stemming from barriers to conduct of randomized trials. This may produce differences in the final quality of evidence in clinical guidelines when compared to adult populations, even for the same clinical topic.

Objectives: To assess the differences of the quality (certainty) of evidence used in paediatric and adult guidelines for the treatment and prevention of venous thromboembolism (VTE) using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and discuss the challenges for better paediatric evidence to inform paediatric clinical recommendations.

Methods: We evaluated two clinical guidelines and two main outcomes in each guideline (one paediatric guideline with 58 PICO (participants, intervention, comparator, outcome) questions, and one adult guideline with 28 questions) that were considered the most critical by panelists of the American Society of Hematology. We measured certainty of evidence, rate of indirectness, use of randomized and non-randomized studies, and the number of participants and studies per question.

Results: We analyzed a total of 58 and 28 PICO questions in the paediatric and adult guidelines, respectively. Certainty of evidence was significantly lower in the paediatric (56 of 58 PICO questions deemed very low certainty; 96.5%) compared to adult guidelines (9 of 28; 32%). Indirect evidence in paediatric guidelines (from adults) was used in 63.9% of their questions; however, in adult populations, indirect evidence was used in 39% of the questions, yet none of the adult guidelines used evidence from paediatric studies, due to full availability of randomized studies.

Conclusions: Evidence used in paediatric guidelines to make clinical recommendations for VTE reflects the gap in high-quality research between adult and paediatric populations for many clinical conditions. This can have an impact on the final recommendations that many organizations provide. This situation is likely to occur in other clinical areas and topics beyond VTE.

Healthcare consumer relevance: Consumers and stakeholders involved in childcare often take information from indirect sources to make healthcare recommendations. We need to provide the best evidence possible for both adult and paediatric populations without gaps in the quality of evidence.

Relevance to patients and consumers: 

Consumers and stakeholders involved in childcare often take information from indirect sources to make health care recommendations. We need to provide the best evidence possible for both adult and paediatric populations without gaps in the quality of evidence.