Published online November 30, 2007
PEDIATRICS Vol. 120 No. 6 December 2007, pp. 1334-1343 (doi:10.1542/peds.2006-3381)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow HTML Page - index.htslp
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Web of Science (3)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Boluyt, N.
Right arrow Articles by Offringa, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Boluyt, N.
Right arrow Articles by Offringa, M.
Related Collections
Right arrow Asthma
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

STATE-OF-THE-ART REVIEW ARTICLE

State of the Evidence on Acute Asthma Management in Children: A Critical Appraisal of Systematic Reviews

Nicole Boluyt, MD, PhDa, Johanna H. van der Lee, MD, PhDa, Virginia A. Moyer, MD, MPHb, Paul L. P. Brand, MD, PhDc and Martin Offringa, MD, PhDa

a Department of Pediatric Clinical Epidemiology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
b Academic General Pediatrics, Baylor College of Medicine, Houston, Texas
c Princess Amalia Children's Clinic, Isala Klinieken, Zwolle, Netherlands

ABSTRACT

OBJECTIVE. Our goal was to evaluate clinical, methodologic, and reporting aspects of systematic reviews on the management of acute asthma in children.

METHODS. We undertook a systematic review of systematic reviews on acute asthma management in children. We identified eligible reviews by searching the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, Medline, and Embase 1990 to March 2006. Data were extracted on clinical issues, methodologic characteristics, and results of the reviews. Methodologic quality was assessed with the Overview Quality Assessment Questionnaire and with additional questions on heterogeneity. Separate reporting on children in mixed adult-pediatric population reviews was assessed. Methodologic quality of systematic reviews published in peer-reviewed journals was compared with Cochrane reviews.

RESULTS. A total of 23 systematic reviews were included: 14 were published in the Cochrane Library, and 9 were published in peer-reviewed journals. Eight reviews included children only, and 15 were mixed-population reviews. The majority of reviews defined the study population as having "acute asthma" without a more precise definition, and 16 different health outcomes were reported. The overall quality according to the Overview Quality Assessment Questionnaire was good, with Cochrane reviews showing minimal flaws and journal reviews showing minor flaws (median scores: 7 vs 5). Results on children were reported separately in 8 of 15 mixed-population reviews. Clinical heterogeneity was explored in only 2 of 23 reviews, and the methods used to identify and address heterogeneity were diverse.

CONCLUSIONS. The methodologic quality of both the Cochrane and journal reviews on the management of acute asthma in children seems good, with Cochrane reviews being more rigorous. However, their usefulness for clinical practice is hampered by a lack of clear definitions of included populations, clinically important health outcomes, and separate reporting on children in mixed reviews. A major threat to these reviews’ validity is the insufficient identification and handling of heterogeneity.

Key Words: acute asthma • review literature • child • evaluation studies • quality assurance/health care

Abbreviations: ED—emergency department • OQAQ—Overview Quality Assessment Questionnaire • FEV1—forced expiratory volume in 1 second • PEF—peak expiratory flow

Accepted Jun 18, 2007.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 Am J EpidemiolHome page
C. Minelli, J. R. Thompson, K. R. Abrams, A. Thakkinstian, and J. Attia
The Quality of Meta-Analyses of Genetic Association Studies: A Review With Recommendations
Am. J. Epidemiol., December 1, 2009; 170(11): 1333 - 1343.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. N. DeMaria
Meta-analysis.
J. Am. Coll. Cardiol., July 15, 2008; 52(3): 237 - 238.
[Full Text] [PDF]