Background
Objective
Methods
Search strategy
Inclusion criteria
Screening and full-text extraction
Data collection form
Analysis
Results
Characteristic | SR reports % (n) | SR protocols % (n) |
---|---|---|
Total number of studies | 248 | 76 |
Population included | ||
Child-only studies | 60.9 (151) | 53.9 (41) |
Mixed child/adult studies | 25.8 (64) | 31.6 (24) |
Community/family/maternal intervention/exposure studies | 13.3 (33) | 14.5 (11) |
Type | ||
Cochrane | 59.7 (148) | 34.2 (26) |
Non-Cochrane | 40.3 (100) | 65.8 (50) |
ICD-10 diagnostic category | ||
Infectious disease and parasitic diseases | 10.5 (26) | 15.8 (12) |
Neoplasms (including oncology) | 2.0 (5) | 3.9 (3) |
Blood, blood-forming organs, and the immune mechanism | 1.2 (3) | 2.6 (2) |
Endocrine and nutritional and metabolic disease | 9.7 (24) | 7.9 (6) |
Mental and behavioral disorders | 11.3 (28) | 11.8 (9) |
Nervous system | 4.8 (12) | 6.6 (5) |
Eye and adnexa | 0.4 (1) | 0.0 (0) |
Ear and mastoid process | 1.6 (4) | 1.3 (1) |
Circulatory system | 1.2 (3) | 1.3 (1) |
Respiratory system | 12.1 (30) | 1.3 (1) |
Digestive system | 6.0 (15) | 3.9 (3) |
Skin and subcutaneous tissue | 0.8 (2) | 0.0 (0) |
Musculoskeletal system and connective tissue | 1.2 (3) | 2.6 (2) |
Genitourinary, childbirth, and the puerperium | 11.3 (28) | 3.9 (3) |
Conditions originating in the perinatal period | 7.7 (19) | 5.3 (4) |
Congenital malformation, deformations, and chromosomal abnormalities | 2.4 (6) | 2.6 (2) |
Symptoms, signs, and abnormal clinical laboratory findings not elsewhere classified | 1.2 (3) | 2.6 (2) |
Injury, poisoning, and consequences of external causes | 5.2 (13) | 7.9 (6) |
External causes of morbidity and mortality | 0.0 (0) | 0.0 (0) |
Factors influencing health status and contact with health services | 0.8 (2) | 10.5 (8) |
Oral health | 0.0 (0) | 0.0 (0) |
No explicit medical condition | 8.1 (20) | 5.3 (4) |
Other | 0.4 (1) | 2.6 (2) |
Intervention type | ||
Drug/natural health products | 49.2 (122) | 36.8 (28) |
Device | 8.5 (21) | 2.6 (2) |
Surgery or radiotherapy | 7.7 (19) | 7.9 (6) |
Rehabilitation or psycho-social | 14.5 (36) | 9.2 (7) |
Vaccine | 0.8 (2) | 2.6 (2) |
Communication, organizational, or education | 9.7 (24) | 22.4 (17) |
Prevention or screening | 2.4 (6) | 3.9 (3) |
Complex intervention (>1 interventions) | 2.4 (6) | 2.6 (2) |
Other | 5.6 (14) | 17.1 (13) |
No explicit exposure or intervention | 5.2 (13) | 5.3 (4) |
Comparison type | ||
Drug/natural health products | 43.5 (108) | 31.6 (24) |
Device | 7.3 (18) | 2.6 (2) |
Surgery or radiotherapy | 4.8 (12) | 5.3 (4) |
Rehabilitation or psycho-social | 9.7 (24) | 6.6 (5) |
Vaccine | 0.8 (2) | 2.6 (2) |
Communication, organizational, or education | 5.2 (13) | 14.5 (11) |
Prevention or screening | 0.8 (2) | 2.6 (2) |
Complex intervention (>1 interventions) | 2.0 (5) | 0.0 (0) |
Other | 8.1 (20) | 15.8 (12) |
No explicit exposure or intervention | 26.2 (65) | 28.9 (22) |
Systematic review and meta-analysis reports
Proportion (%) of “Yes” responses for the total (no.) of reviews eligible for scoring | |||||||||
---|---|---|---|---|---|---|---|---|---|
Type of review | Intervention/exposure group | ||||||||
Itema number | Item | Overall (N = 248) | Cochrane (N = 100) | Non-Cochrane (N = 148) |
p value | Children only (N = 151) | Children and adults (N = 64) | Family and maternal (N = 33) |
p value |
Title | |||||||||
1) | Identify the report as a systematic review, meta-analysis, or both for pediatric population as a focus of review, if applicable | 62.1 (248) | 67 (100) | 58.8 (148) | 0.194 | 78.8 (151) | 26.6 (64) | 54.5 (33) |
p < 0.01* |
Abstract | |||||||||
2) | Provide a structured summary including, as applicable, background; objectives; data sources; study eligibility criteria, including specifying targeted pediatric age group(s), interventions; primary and secondary outcomes; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number | 9.3 (248) | 16 (100) | 4.7 (148) |
p < 0.01* | 12.6 (151) | 3.1 (64) | 6.1 (33) | 0.079 |
2a)
|
If a systematic review includes both adults and children, describe a subgroup analysis for the targeted pediatric age group(s) in the methods and results of the abstract
| 11.6 (69) | 9.1 (33) | 13.9 (36) | 0.538 | NA | 11.3 (62) | 14.3 (7) | 0.815 |
2b)
|
Describe applicability or limits of applicability of the results of the systematic review to the targeted pediatric age group(s)
| 62.1 (248) | 65 (100) | 60.1 (148) | 0.440 | 75.5 (151) | 35.9 (64) | 51.5 (33) |
p < 0.01* |
Introduction | |||||||||
Rationale | |||||||||
3) | Describe the rationale for the review in the context of what is already known | ||||||||
3a)
|
In the contexts of the synthesized evidence in adults or other pediatric groups (non-targeted), explain the rationale for synthesizing evidence for the targeted pediatric age group(s). Provide hypotheses that relate to the targeted pediatric age group(s)
| 3.6 (248) | 5 (100) | 2.7 (148) | 0.345 | 6 (151) | 0 (64) | 0 (33) | 0.066 |
Objectives | |||||||||
4) | Provide an explicit statement of questions being addressed with reference to targeted pediatric age groups, interventions, comparisons, outcomes, and study design (PICOS) | 0.8 (248) | 2 (100) | 0 (148) | 0.087 | 0.7 (151) | 1.6 (64) | 0 (33) | 0.703 |
Methods | |||||||||
Eligibility criteria | |||||||||
6) | Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale | ||||||||
6a)
|
Justify the targeted pediatric age group(s) selected
| 74.2 (248) | 73 (100) | 75 (148) | 0.725 | 88.7 (151) | 34.4 (64) | 84.8 (33) |
p < 0.01* |
6b)
|
Intervention: Justify the intervention for the targeted pediatric age group(s) addressing potential age-related differences in intervention effects
| 67.7 (248) | 65 (100) | 69.6 (148) | 0.449 | 78.1 (151) | 32.8 (64) | 87.9 (33) |
p < 0.01* |
6c)
|
Provide rationale for extrapolation or adaptation of adult intervention, if any
| 29.6 (27) | 28.6 (7) | 30 (20) | 0.946 | 40 (20) | 0 (7) | 0 (0) | 0.037 |
6d)
|
Comparators: Explain the choice of comparator(s) and, if applicable, evidence for the active comparator and/or standard of care for targeted pediatric age group(s)
| 9.7 (248) | 11 (100) | 8.8 (148) | 0.564 | 9.9 (151) | 7.8 (64) | 12.1 (33) | 0.759 |
6e)
|
Outcomes: List and define all the primary outcomes addressed for the targeted pediatric age group(s). List and define growth and development outcomes and adverse outcomes (events), if applicable
| 41.1 (248) | 57 (100) | 30.4 (148) |
p < 0.01* | 51.7 (151) | 10.9 (64) | 51.5 (33) |
p < 0.01* |
6f)
|
Outcomes: Explain the clinical relevance of the selected outcomes (benefits and harms) for the targeted pediatric age group(s)
| 34.3 (248) | 38 (100) | 31.8 (148) | 0.312 | 40.4 (151) | 20.3 (64) | 33.3 (33) | 0.018* |
6g)
|
Outcomes: Explain the validity, feasibility, and responsiveness of the outcome measures for the pre-targeted pediatric age group(s)
| 0 (248) | 0 (100) | 0 (148) |
p > .999 | 0 (151) | 0 (64) | 0 (33) |
p > .999 |
Search | |||||||||
8) | Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated | ||||||||
8a)
|
Describe the search strategy and terms (including database specific MeSH terms for pediatric population) used to address the targeted pediatric age group(s)
| 44 (248) | 38 (100) | 48 (148) | 0.124 | 60.3 (151) | 3.1 (64) | 48.5 (33) |
p < 0.01* |
Summary measures | |||||||||
13) | State the principal summary measures (e.g., risk ratio, difference in means) | ||||||||
13a)
|
If data were available for adult and pediatrics, provide summary measures for adult and targeted pediatric age group(s) separately
| 2.2 (89) | 2.1 (47) | 2.3 (42) | 0.950 | NA (NA) | 3.2 (63) | 0 (26) |
p < 0.01* |
Synthesis of results | |||||||||
14) | Describe the methods of handling data and combining results of studies if done, including measures of consistency (e.g., I2) for each meta-analysis | ||||||||
14a)
|
For studies that included pediatrics and adults without a subgroup analysis of the pediatric population, describe how the data on targeted pediatric age group(s) were used in the analysis
| 0 (89) | 0 (47) | 0 (42) |
p > .999 | NA (NA) | 0 (63) | 0 (26) |
p > .999 |
Additional analyses | |||||||||
16) | Describe methods of additional analyses (e.g., sensitivity or subgroup analyses for targeted pediatric age group(s), meta-regression), if done, indicating which were pre-specified | 54.9 (142) | 64.1 (92) | 38 (50) |
p < 0.01* | 54.1 (74) | 68.9 (45) | 30.4 (23) |
p < 0.01* |
Results | |||||||||
Study characteristics | |||||||||
18) | For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations | ||||||||
18a)
|
Provide sample size of pediatric group and subgroups (if applicable) for each study.
| 72.6 (234) | 74.2 (89) | 71.7 (145) | 0.686 | 83.6 (146) | 42.6 (61) | 81.5 (27) |
p < 0.01* |
Synthesis of results | |||||||||
21) | Present results of each meta-analysis done, including confidence intervals and measures of consistency. | ||||||||
21a)
|
Report the numbers of included studies with pediatric participants. Where applicable, report the number of events and total pediatric population on which the result synthesis is based
| 60.7 (168) | 70.5 (78) | 52.2 (90) |
0.018* | 79 (100) | 20.4 (49) | 68.4 (19) |
p < 0.01* |
Additional analysis | |||||||||
23) | Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses for the targeted pediatric age group(s), meta-regression [see Item 16]) | 54.0 (87) | 65.1 (43) | 43.2 (44) | 0.046* | 53.2 (47) | 58.1 (31) | 44.4 (9) | 0.743 |
Discussion | |||||||||
Summary of evidence | |||||||||
24) | Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, i.e., children, carer such as parents or legal guardians, and policy makers). | 74.5 (239) | 70.7 (92) | 76.9 (147) | 0.286 | 83.8 (148) | 48.4 (62) | 82.8 (29) |
p < 0.01* |
Limitations | |||||||||
25) | Discuss limitations at study and outcome level (e.g., risk of bias, growth and developmental outcomes in children, and minimally important differences in children) at targeted pediatric age group(s) level (e.g., newborn and infant under 5 years), and at review level (e.g., incomplete retrieval of identified research, reporting bias and paucity of research in children) | 35.8 (232) | 29.4 (85) | 39.5 (147) | 0.128 | 46.9 (145) | 16.4 (61) | 19.2 (26) |
p < 0.01* |
Conclusions | |||||||||
26) | Provide a general interpretation of the results in the context of other evidence (e.g., evidence from adult studies and pre-clinical studies). Implications for future research in practice, or policy related to the targeted pediatric age group(s)
| 43.9 (244) | 45.8 (96) | 42.6 (148) | 0.624 | 52.7 (150) | 17.5 (63) | 54.8 (31) |
p < 0.01* |
Funding | |||||||||
27) | Describe sources of funding for the systematic review and other support (e.g., supply of data) and role of funders for the systematic review | ||||||||
27a)
|
For each included trial in a systematic review, indicate (a plan to include) the source of financial support (such as government, academia or industry), if any, in the trial(s)
| 5.6 (248) | 8 (100) | 4.1 (148) | 0.190 | 4 (151) | 10.9 (64) | 3 (33) | 0.113 |
Title and abstract
Introduction
Methods
Results
Discussion
Conclusions
Funding
Systematic review and meta-analysis protocols
Proportion (%) of “Yes” responses for the total (no.) of reviews eligible for scoring | |||||||||
---|---|---|---|---|---|---|---|---|---|
Type of review | Intervention/exposure group | ||||||||
Itema number | Item | Overall (N = 76) | Cochrane (N = 50) | Non-Cochrane (N = 26) |
p value | Children only (N = 41) | Children and adults (N = 24) | Family and maternal (N = 11) |
p value |
Title
| |||||||||
1) | Identify the protocol as a systematic review, meta-analysis, or both for pediatric population as a focus of review, if applicable | 72.4 (76) | 88.5 (50) | 64 (26) | 0.015* | 92.7 (41) | 29.2 (24) | 90.9 (11) |
p < 0.01* |
Support | |||||||||
5a) | Indicate sources of financial or other support for the review | ||||||||
5b) | Provide name for the review funder and/or sponsor | ||||||||
5c) | Describe roles of funder(s), sponsor(s), and/or institution(s), if any, in developing the protocol | ||||||||
5d)
|
For each included trial in a systematic review, indicate (a plan to include) the source of financial support (such as government, academia, or industry), if any, in the trial(s)
| 13.2 (76) | 30.8 (50) | 4 (26) | 0.010* | 19.5 (41) | 8.3 (24) | 0 (11) | 0.178 |
Introduction
| |||||||||
Rationale | |||||||||
6) | Describe the rationale for the review in the context of what is already known | ||||||||
6a)
|
In the contexts of the synthesized evidence in adults or other pediatric groups (non-targeted), explain the rationale for synthesizing evidence for the targeted pediatric age group(s). Provide hypotheses that relate to the targeted pediatric age group(s)
| 1.3 (76) | 0 (50) | 2 (26) | 0.321 | 2.4 (41) | 0 (24) | 0 (11) | 0.682 |
Objectives | |||||||||
7) | Provide an explicit statement of questions the review will address with reference to targeted pediatric age groups, interventions, comparisons, outcomes, and study design (PICOS). | 0 (76) | 0 (50) | 0 (26) |
p > 0.999 | 0 (41) | 0 (24) | 0 (11) |
p > 0.999 |
Methods | |||||||||
Eligibility criteria | |||||||||
8) | Specify the study characteristics (such as PICO, study design, setting, time frame) and report characteristics (such as years considered, language, publication status) to be used as criteria for eligibility for the review | ||||||||
8a)
|
Justify the targeted pediatric age group(s) selected.
| 64.5 (76) | 84.6 (50) | 54 (26) |
p < 0.01* | 78 (41) | 45.8 (24) | 54.5 (11) | 0.022* |
8b)
|
Intervention: Justify the intervention for the targeted pediatric age group(s) addressing potential age-related differences in intervention effects
| 55.3 (76) | 76.9 (50) | 44 (26) |
p < 0.01* | 61 (41) | 37.5 (24) | 72.7 (11) | 0.075* |
8c)
|
Provide rationale for extrapolation or adaptation of adult intervention, if any
| 16.7 (18) | 20 (13) | 15.4 (5) | 0.826 | 33.3 (6) | 9.1 (11) | 0 (1) | 0.410 |
8d)
|
Comparators: Explain the choice of comparator(s) and, if applicable, evidence for the active comparator and/or standard of care for targeted pediatric age group(s)
| 17.1 (76) | 26.9 (50) | 12 (26) | 0.142 | 26.8 (41) | 8.3 (24) | 0 (11) | 0.050 |
8e)
|
Outcomes: List and define all the primary outcomes addressed for the targeted pediatric age group(s). List and define growth and development outcomes and adverse outcomes (events), if applicable
| 55.3 (76) | 80.8 (50) | 42 (26) |
p < 0.01* | 78 (41) | 12.5 (24) | 63.6 (11) |
p < 0.01* |
8f)
|
Outcomes: Explain the clinical relevance of the selected outcomes (benefits and harms) for the targeted pediatric age group(s)
| 28.9 (76) | 23.1 (50) | 32 (26) | 0.405 | 26.8 (41) | 29.2 (24) | 36.4 (11) | 0.797 |
8g)
|
Outcomes: Explain the validity, feasibility, and responsiveness of the outcome measures for the pre-targeted pediatric age group(s)
| 0 (76) | 0 (50) | 0 (26) |
p > 0.999 | 0 (41) | 0 (24) | 0 (11) |
p > 0.999 |
Search strategy | |||||||||
10) | Present draft of search strategy to be used for at least one electronic database, including planned limits, such that it could be repeated | ||||||||
10a)
| Describe the search strategy and terms (including database specific MeSH terms for pediatric population) used to address the targeted pediatric age group(s)
| 48.7 (76) | 53.8 (50) | 46 (26) | 0.520 | 58.5 (41) | 25 (24) | 63.6 (11) | 0.017* |
Data synthesis | |||||||||
15b) | If data are appropriate for quantitative synthesis, describe planned summary measures, methods of handling data and methods of combining data from studies, including any planned exploration of consistency (such as I2, Kendall’sτ) | ||||||||
15b)
|
For studies that included pediatrics and adults without a subgroup analysis of the pediatric population, describe how the data on targeted pediatric age group(s) were used in the analysis
| 0 (27) | 0 (21) | 0 (6) |
p > 0.999 | 0 (0) | 0 (24) | 0 (3) |
p > 0.999 |
Additional analyses | |||||||||
15c) | Describe methods of additional analyses (e.g., sensitivity or subgroup analyses for targeted pediatric age group(s), meta-regression), if done, indicating which were pre-specified | 61 (59) | 58.3 (35) | 62.9 (24) | 0.730 | 53.3 (30) | 68.4 (19) | 70 (10) | 0.454 |
Title
Support
Introduction
Methods
Systematic reviews reports vs. systematic review protocols
Proportion (%) of “Yes” responses for the total (no.) of reviews eligible for scoring | ||||
---|---|---|---|---|
Itema number | Item | SR reports (N = 248) | SR protocols (N = 76) |
p value |
Title
| ||||
1/1a) | Identify the report as a systematic review, meta-analysis, or both for pediatric population as a focus of review, if applicable | 62.1 (248) | 72.4 (76) | 0.102 |
Introduction
| ||||
Rationale | ||||
5/6) | Describe the rationale for the review in the context of what is already known | |||
In the contexts of the synthesized evidence in adults or other pediatric groups (non-targeted), explain the rationale for synthesizing evidence for the targeted pediatric age group(s). Provide hypotheses that relate to the targeted pediatric age group(s)
| 3.6 (248) | 1.3 (76) | 0.309 | |
Objectives | ||||
4/7) | Provide an explicit statement of questions being addressed with reference to targeted pediatric age groups, interventions, comparisons, outcomes, and study design (PICOS) | 0.8 (248) | 0 (76) | 0.433 |
Methods
| ||||
Eligibility criteria | ||||
6/8) | Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale | |||
6a/8a)
|
Justify the targeted pediatric age group(s) selected
| 74.2 (248) | 64.5 (76) | 0.1 |
6b/8b)
|
Intervention: Justify the intervention for the targeted pediatric age group(s) addressing potential age-related differences in intervention effects
| 67.7 (248) | 55.3 (76) | 0.047* |
6c/8c)
|
Provide rationale for extrapolation or adaptation of adult intervention, if any
| 29.6 (27) | 16.7 (18) | 0.331 |
6d/8d)
|
Comparators: Explain the choice of comparator(s) and, if applicable, evidence for the active comparator and/or standard of care for targeted pediatric age group(s)
| 9.7 (248) | 17.1 (76) | 0.076 |
6e/8e)
|
Outcomes: List and define all the primary outcomes addressed for the targeted pediatric age group(s). List and define growth and development outcomes, adverse outcomes (events), if applicable
| 41.1 (248) | 55.3 (76) | 0.031* |
6f/8f)
|
Outcomes: Explain the clinical relevance of the selected outcomes (benefits and harms) for the targeted pediatric age group(s)
| 34.3 (248) | 28.9 (76) | 0.388 |
6g/8g)
|
Outcomes: Explain the validity, feasibility and responsiveness of the outcome measures for the pre-targeted pediatric age group(s)
| 0 (248) | 0 (76) |
p > 0.999 |
Search | ||||
8/10) | Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated | |||
8a/10a)
|
Describe the search strategy and terms (including database specific MeSH terms for pediatric population) used to address the targeted pediatric age group(s)
| 44 (248) | 48.7 (76) | 0.469 |
Synthesis of results | ||||
14/15b) | Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis | |||
14a/15b)
|
For studies that included pediatrics and adults without a subgroup analysis of the pediatric population, describe how the data on targeted pediatric age group(s) were used in the analysis
| 0 (89) | 0 (27) |
p > 0.999 |
Additional analyses | ||||
16/15c) | Describe methods of additional analyses (e.g., sensitivity or subgroup analyses for targeted pediatric age group(s), meta-regression), if done, indicating which were pre-specified | 54.9 (142) | 61 (59) | 0.429 |
Funding
| ||||
27/5) | Describe sources of funding for the systematic review and other support (e.g., supply of data) and role of funders for the systematic review | |||
27a/5a)
|
For each included trial in a systematic review, indicate (a plan to include) the source of financial support (such as Government, Academia or Industry), if any, in the trial(s)
| 5.6 (248) | 13.2 (76) | 0.03* |