The Journal of Pediatrics
Volume 157, Issue 2 , Pages 322-330.e17, August 2010

Comparative Effectiveness of Medical Interventions in Adults Versus Children

  • Despina G. Contopoulos-Ioannidis, MD

      Affiliations

    • Department of Pediatrics, University of Ioannina School of Medicine, Ioannina, Greece
    • ,
  • Maria S. Baltogianni, MD

      Affiliations

    • Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
    • Neonatal Intensive Care Unit, University Hospital, Ioannina, Greece
    • ,
  • John P.A. Ioannidis, MD

      Affiliations

    • Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
    • Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
    • Biomedical Research Institute, Foundation for Research and Technology-Hellas, Ioannina, Greece
    • Department of Epidemiology, Harvard School of Public Health, Boston, MA
    • Corresponding Author InformationReprint requests: Dr John P.A. Ioannidis, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece, 45110.

Received 14 August 2009; received in revised form 15 January 2010; accepted 9 February 2010. published online 03 May 2010.

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.

CDSR, Cochrane Database of Systematic Reviews, OR, Odds ratio, ROR, Relative odds ratio, sROR, Summary ROR

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 The authors declare no conflicts of interest.

PII: S0022-3476(10)00121-6

doi:10.1016/j.jpeds.2010.02.011

The Journal of Pediatrics
Volume 157, Issue 2 , Pages 322-330.e17, August 2010

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