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The role and limitations of Cochrane reviews at the bedside: a systematic synopsis of five pediatric subspecialties

Summary

Background

Cochrane meta-analyses provide the physician at the bedside with the most relevant, up-to-date clinical information. However, implementation of evidence-based medicine (EBM) at the bedside may be difficult for a variety of reasons. The aim of this study was to assess relevant issues and obstacles related to implementing EBM in pediatrics in real life at the bedside/cotside.

Methods

We performed five systematic literature reviews of all published Cochrane reviews in neonatology (1996–2010), pediatric neurology (1996–2010), pediatric gastroenterology (1993–2012), pediatric cardiology (2001–2015), and complementary and alternative medicine (1996–2012; CAM) in children and neonates. In all five analyses, the main outcome variables were percentage of reviews concluding that a certain intervention provides a benefit, percentage of reviews concluding that a certain intervention should not be performed, and percentage of studies concluding that the current level of evidence is inconclusive.

Results

In all five areas of pediatrics, a substantial number of Cochrane reviews yielded inconclusive data (neonatology: 46.6%; neuropediatrics: 26.8%; pediatric gastroenterology: 27.9%; pediatric cardiology: 42.9%; complementary and alternative medicine: 66.9%).

Conclusions

Our up-dated systematic synopsis reiterates the need for high-quality, sophisticated research to reduce the number of inconclusive meta-analyses in the field of pediatrics—most importantly in the field of complementary and alternative medicine (CAM), neonatology, and pediatric cardiology. The realization of high-quality, clinically driven research will in turn yield more systematic reviews with a clear conclusion (e. g., in favor or against a certain intervention, or treatment modality), thus, substantively decreasing the proportion of inconclusive reviews.

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Abbreviations

CAM:

Complementary and alternative medicine

EBM:

Evidence-based medicine

ELBW:

Extremely low birth weight

RCT:

Randomized controlled trial

VLBW:

Very low birth weight

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Correspondence to Sascha Meyer.

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Conflict of interest

S. Meyer, M. Poryo, S. Khosrawikatoli, Y. Goda, and M. Zemlin declare that they have no competing interests.

Additional information

Contributors S. Meyer was responsible for study design, data analysis and synthesis, and writing of the manuscript; M. Poryo was responsible for data analysis and synthesis, and critical revision of the manuscript; S. Khosrawikatoli was involved in data compilation and analysis; Y. Goda was involved in data compilation and analysis; M. Zemlin was responsible for data analysis and critical review of the manuscript; S. Meyer and M. Poryo contributed equally to this work.

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Meyer, S., Poryo, M., Khosrawikatoli, S. et al. The role and limitations of Cochrane reviews at the bedside: a systematic synopsis of five pediatric subspecialties. Wien Med Wochenschr 167, 276–281 (2017). https://doi.org/10.1007/s10354-017-0549-3

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  • DOI: https://doi.org/10.1007/s10354-017-0549-3

Keywords

  • Complementary and alternative medicine
  • Evidence-based medicine
  • Neonatology
  • Neuropediatrics
  • Pediatric gastroenterology
  • Pediatric cardiology