Definitions of Pediatric Functional Abdominal Pain Disorders and Outcome Measures: A Systematic Review

Objective: To systematically review definitions of functional abdominal pain orders (FAPDs) and outcome measures used in therapeutic randomized controlled trials in pediatric FAPDs adhering to the Outcome Measures in Rheumatology recommendations. Study design: Cochrane, MEDLINE, Embase, and Cinahl databases were systematically searched from inception to April 2018. English-written therapeutic randomized controlled trials concerning FAPDs in children aged 4-18 years were included. Definitions of FAPDs, interventions, outcome measures, measurement instruments, and outcome assessors of each study were tabulated descriptively. Quality was assessed using the Delphi List. Results: A total of 4771 articles were found, of which 64 articles were included (n = 25, 39% of high methodologic quality). The Rome III (50%), Rome II (17%), Apley (16%), and author-defined (17%) criteria were used to define FAPDs. Fourteen studies (22%) assessed a pharmacologic, 25 (39%) a dietary, and 25 (39%) a psychosocial intervention. Forty-four studies (69%) predefined their primary outcomes. In total, 211 reported predefined outcome measures were grouped into 23 different outcome domains; the majority being patient-reported (n = 27, 61%). Of the 14 studies that evaluated a pharmacologic intervention, 12 (86%) reported on adverse events. Conclusions: Studies on pediatric FAPDs are of limited methodologic quality and show large heterogeneity and inconsistency in defining FAPDs and outcome measures used. Development of a core outcome set is needed to make comparison between intervention studies possible

Exacerbations in adults with asthma : A systematic review and external validation of prediction models

BACKGROUND: Several prediction models assessing future risk of exacerbations in adult patients with asthma have been published. Applicability of these models is uncertain because their predictive performance has often not been assessed beyond the population in which they were derived. OBJECTIVE: This study aimed to identify and critically appraise prediction models for asthma exacerbations and validate them in two clinically distinct populations. METHODS: PubMed and EMBASE were searched to April 2017 for reports describing adult asthma populations in which multivariable models were constructed to predict exacerbations during any time frame. After critical appraisal, the models͛ predictive performances were assessed in a primary and a secondary care population for: author-defined exacerbations and for ATS/ERS-defined severe exacerbations. RESULTS: We found 12 reports from which 24 prediction models were evaluated. Three predictors (previous healthcare-utilisation, symptoms, and spirometry values) were retained in most models. Assessment was hampered by sub-optimal methodology and reporting, and by differences in exacerbation outcomes. Discrimination (AUROC) of models for author-defined exacerbations was better in the primary care population (mean 0.71) than in the secondary care population (mean 0.60); and similar (0.65 and 0.62 respectively) for ATS/ERS defined severe exacerbations. Model calibration was generally poor, but consistent between the two populations. CONCLUSION: The preservation of three predictors in models derived from variable populations and the fairly consistent predictive properties of most models in two distinct validation populations suggest the feasibility of a generalizable model predicting severe exacerbations. Nevertheless, improvement of the models is warranted as predictive performances are below the desired level