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BMC Pediatrics

, 17:155

Global and public health and healthcare


BackgroundSystematic reviews support health systems and clinical decision-making by identifying and summarizing all existing studies on a particular topic. In 2009, a comprehensive description of child-relevant systematic reviews published in the Cochrane Database of Systematic Reviews was compiled. This study aims to provide an update, and to describe these systematic reviews according to their content and methodological approaches.

MethodsAll child-relevant systematic reviews published by the Cochrane Collaboration in the Cochrane Database of Systematic Reviews CDSR as of March, 2013 were identified and described in relation to their content and methodological approaches. This step equated to an update of the Child Health Field Review Register CHFRR. The content of the updated CHFRR was compared to the published 2009 CHFRR description regarding clinical and methodological characteristics, using bivariate analyses. As the Cochrane Collaboration has recognized that disease burden should guide research prioritization, we extracted data from the Global and National Burden of Diseases and Injuries Among Children and Adolescents Between 1990 and 2013 study in order to map the distribution of the burden of disease in child health to the distribution of evidence across Review Groups in the CHFRR.

ResultsOf the 5,520 potential Cochrane systematic reviews identified, 1,293 23.4% were child-relevant an increase of 24% since 2009. Overall, these reviews included 16,738 primary studies. The most commonly represented Review Groups were Airways 11.5%, Cystic Fibrosis and Genetic Diseases 7.9%, Acute Respiratory Infections 7.8%, Developmental, Psychological and Learning Problems 6.7%, and Infectious Diseases 6.2%. Corresponding authors were most often from Europe 51%, North America 15%, and Australia 15%. The majority of systematic reviews examined pharmacological interventions alone 52% compared to 59% in 2009. Out of 611 reviews that were assessed as up-to-date, GRADE was used in 204 35% reviews to assess the overall quality of the evidence, which was often moderate 35.6% or low 37.8% for primary outcomes. Ninety percent of reviews that were assessed as up to date used the Cochrane Risk of Bias tool, or a modified version, to assess methodological quality. Most reviews conducted one or more meta-analyses 73%. Among the 25 leading causes of death globally, the Review Groups associated with the largest number of causes were: 1 Infectious Diseases, 2 Anaesthesia, Critical, and Emergency Care, 3 Injuries, 4 Pregnancy and Childbirth PC, and 5 Neonatal. There were large discrepancies between the number of causes of mortality that each Review Group was associated with and the total amount of evidence each Review Group contributed to the CHFRR. Ninety-eight percent of the causes of mortality in 2013 were from developing nations, but only 224 17.3% reviews had corresponding authors from developing countries.

ConclusionThe content and methodological characteristics of child-relevant systematic reviews in the Cochrane CHFRR have been described in detail. There were modest advances in methods between 2009 and 2013. Systematic reviews contained in the CDSR offer an important resource for researcher’s, clinicians and policy makers by synthesizing an extensive body of primary research. Further content analysis will allow the identification of clinical topics of greatest priority for future systematic reviews in child health.

KeywordsSystematic reviews Meta-analyses Child Pediatrics Reporting quality Methods AbbreviationsACEAnaesthesia, Critical and Emergency Care

ARIAcute Respiratory Infections

CDSRCochrane Database of Systematic Reviews

CF and Genetic DiseasesCystic Fibrosis and Genetic Diseases

CHFRRChild Health Field Review Register

CRGsCochrane Review Groups

DPLPDevelopmental, Psychosocial and Learning Problems

GRADEGrading of Recommendations Assessment, Development and Evaluation


IBDInflammatory Bowel Diseases

IDInfectious Diseases

IQRsInterquartile ranges

L-MLow and middle-income

PCPregnancy and Childbirth

RCTsRandomized controlled trials

RoBRisk of bias

SDsStandard deviations

SRsSystematic reviews

Electronic supplementary materialThe online version of this article doi:10.1186-s12887-017-0908-7 contains supplementary material, which is available to authorized users.

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Autor: Katelynn Crick - Denise Thomson - Ricardo M. Fernandes - Megan Nuspl - Dean T. Eurich - Brian H. Rowe - Lisa Hartling


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