Analysis of the evidence underpinning the American Academy Orthopaedic Surgery pediatrics clinical practice guidelines

Abstract

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 methodological quality and reporting of RCTs. This is especially notable within the American Academy of Orthopaedic Surgery (AAOS) CPGs. We aim to evaluate the methodological quality and reporting, as well as, analyze risk of bias of RCTs underlying recommendations within AAOS Pediatric CPGs.

Study Design: We located all AAOS Pediatric CPGs using OrthoGuidelines.org. Each CPG was evaluated for RCTs cited within the references. Descriptive statistics were recorded and multiple regressions were used to account for whether publication year, intervention type, funding, conflict of interest statement and risk of bias accounted for variance in CONSORT scores. A Mann-Whitney analysis was completed to compare CONSORT studies published before and after 2010.

Results: Mean CONSORT adherence was 69.8% of the 23 RCTs evaluated. Items of the lowest CONSORT adherence included items 10, 23, and 24 while items 2a, 13a, and 18 showed the highest adherence. Ten RCTs (43.5%) had “low” risk of bias while 5 RCTs (21.7%) were of “some concerns,” and 8 RCTs (34.8%) received a “high” designation for risk of bias. There were no statistically significant associations in the bivariate regression analysis. The Mann-Whitney analysis revealed no significant difference between studies published before and after 2010.

Conclusions: Our results suggest that CONSORT adherence within the RCTs of the AAOS Pediatric CPGs is suboptimal —relying on evidence that, in some cases, is more than 20 years old. Many of the RCTs cited as supporting evidence have increased risk of bias. Altogether, these CPGs may need to be updated or expanded to include more recent evidence relevant to pediatric orthopedic surgery.