Role of Cochrane reviews in pediatric neurology

Abstract

Evidence-based medicine in pediatric neurology is considered an important contributor to the best quality of care. We performed a literature review of all Cochrane reviews from 1996-2010 in pediatric neurology. Some reviews concluded that a certain intervention provided benefits, some concluded that certain interventions should not be performed, and some concluded that the current level of evidence was inconclusive. One hundred and twelve reviews were enrolled; only 17 exclusively involved children. In 33/112, a clear recommendation in favor of a certain intervention was given, 11/112 issued a conditionally positive recommendation, and 32/112 concluded that certain interventions should not be performed. Six concluded that no differences were evident between different therapeutic/treatment options. Thirty were inconclusive. The proportion of inconclusive reviews increased during three a priori defined time intervals. Common criticisms regarding quality of enrolled studies included heterogeneous study populations (49/112), a small number of participants (48/112), and a lack of comparability of studies (40/112). An ongoing need exists for high-quality research to reduce the proportion of inconclusive meta-analyses. Further randomized, controlled trials should involve only pediatric populations.