TY - JOUR
T1 - An Analysis of the Evidence Underpinning the American Academy Orthopaedic Surgery Pediatrics Clinical Practice Guidelines
AU - Batioja, Kelsi Emmons
AU - Nguyen, Tiffany
AU - Anderson, J Michael
AU - Detweiler, Byron
AU - Checketts, Jake
AU - Torgerson, Trevor
AU - Hartwell, Micah
AU - Vassar, Matt
N1 - Funding Information:
M.H. reports receiving funding from the National Institute of Justice for work unrelated to the current subject. M.V. reports receipt of funding from the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, the US Office of Research Integrity, Oklahoma Center for Advancement of Science and Technology, and internal grants from Oklahoma State University Center for Health Sciences—all outside of the present work. The remaining authors declare no conflicts of interest.
Publisher Copyright:
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2022/2/1
Y1 - 2022/2/1
N2 - Background: Randomized control trials (RCTs) serve as evidentiary support for recommendations underpinning clinical practice guidelines (CPGs) with the goal of optimizing patient care. A knowledge gap exists within scientific literature when evaluating the quality of RCTs used as evidence in the American Academy of Orthopaedic Surgery (AAOS) pediatric CPGs. We aim to evaluate the reporting quality and risk of bias in RCTs underlying AAOS Pediatric CPG recommendations. Methods: We located all AAOS Pediatric CPGs. We then extracted all RCTs from the CPG reference sections. All included RCTs were evaluated using the Consolidated Standards of Reporting Trials (CONSORT) checklist and Cochrane Collaboration risk of bias assessment tool (RoB 2.0). Descriptive statistics were recorded, and bivariate analysis was used to account for variance in CONSORT scores. A Mann-Whitney U test was completed to compare CONSORT studies published before and after 2010. Results: Three CPGs and 23 RCTs met inclusion criteria. Mean CONSORT adherence was 69.8% (21.6/31). The lowest adhered to CONSORT items were 10, 23, and 24, while items 2a, 13a, and 18 displayed the highest adherence. Ten RCTs (43.5%, 10/23) had “low” risk of bias, 5 RCTs (21.7%, 5/23) were of “some concerns,” and 8 RCTs (34.8%, 8/23) received a “high” designation for risk of bias. There were no statistically significant associations in the bivariate regression analysis or Mann-Whitney U test. Conclusions: Our results suggest that CONSORT adherence within RCTs used as evidence in AAOS Pediatric CPGs is substandard-relying on evidence that, in some cases, is > 20 years old. Many of the RCTs cited as supporting evidence have a “high” risk of bias. Altogether, these CPGs may need to be updated or expanded to include more recent evidence relevant to pediatric orthopaedic surgery.
AB - Background: Randomized control trials (RCTs) serve as evidentiary support for recommendations underpinning clinical practice guidelines (CPGs) with the goal of optimizing patient care. A knowledge gap exists within scientific literature when evaluating the quality of RCTs used as evidence in the American Academy of Orthopaedic Surgery (AAOS) pediatric CPGs. We aim to evaluate the reporting quality and risk of bias in RCTs underlying AAOS Pediatric CPG recommendations. Methods: We located all AAOS Pediatric CPGs. We then extracted all RCTs from the CPG reference sections. All included RCTs were evaluated using the Consolidated Standards of Reporting Trials (CONSORT) checklist and Cochrane Collaboration risk of bias assessment tool (RoB 2.0). Descriptive statistics were recorded, and bivariate analysis was used to account for variance in CONSORT scores. A Mann-Whitney U test was completed to compare CONSORT studies published before and after 2010. Results: Three CPGs and 23 RCTs met inclusion criteria. Mean CONSORT adherence was 69.8% (21.6/31). The lowest adhered to CONSORT items were 10, 23, and 24, while items 2a, 13a, and 18 displayed the highest adherence. Ten RCTs (43.5%, 10/23) had “low” risk of bias, 5 RCTs (21.7%, 5/23) were of “some concerns,” and 8 RCTs (34.8%, 8/23) received a “high” designation for risk of bias. There were no statistically significant associations in the bivariate regression analysis or Mann-Whitney U test. Conclusions: Our results suggest that CONSORT adherence within RCTs used as evidence in AAOS Pediatric CPGs is substandard-relying on evidence that, in some cases, is > 20 years old. Many of the RCTs cited as supporting evidence have a “high” risk of bias. Altogether, these CPGs may need to be updated or expanded to include more recent evidence relevant to pediatric orthopaedic surgery.
KW - CONSORT
KW - clinical practice guidelines
KW - methodological safeguards
KW - pediatric orthopaedics
KW - quality
KW - randomized control trials
KW - reporting
KW - risk of bias
UR - http://www.scopus.com/inward/record.url?scp=85119450274&partnerID=8YFLogxK
U2 - 10.1097/BPO.0000000000002002
DO - 10.1097/BPO.0000000000002002
M3 - Article
C2 - 34739437
AN - SCOPUS:85119450274
SN - 0271-6798
VL - 42
SP - E218-E223
JO - Journal of Pediatric Orthopaedics
JF - Journal of Pediatric Orthopaedics
IS - 2
ER -