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J Pediatr. 2010 Aug;157(2):322-330.e17. doi: 10.1016/j.jpeds.2010.02.011.

Comparative effectiveness of medical interventions in adults versus children.

Author information

1
Department of Pediatrics, University of Ioannina School of Medicine, Ioannina, Greece.

Abstract

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.

PMID:
20434730
DOI:
10.1016/j.jpeds.2010.02.011
[Indexed for MEDLINE]

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