A Core Outcome Set for Children With Feeding Tubes and Neurologic Impairment: A Systematic Review

Pediatrics. 2016 Jul;138(1):e20153967. doi: 10.1542/peds.2015-3967.

Abstract

Context: Uncertainty exists about the impacts of feeding tubes on neurologically impaired children. Core outcome sets (COS) standardize outcome selection, definition, measurement, and reporting.

Objective: To synthesize an evidence base of qualitative data on all outcomes selected and/or reported for neurologically impaired children 0 to 18 years living with gastrostomy/gastrojejunostomy tubes.

Data sources: Medline, Embase, and Cochrane Register databases searched from inception to March 2014.

Study selection: Articles examining health outcomes of neurologically impaired children living with feeding tubes.

Data extraction: Outcomes were extracted and assigned to modified Outcome Measures in Rheumatology 2.0 Filter core areas; death, life impact, resource use, pathophysiological manifestations, growth and development.

Results: We identified 120 unique outcomes with substantial heterogeneity in definition, measurement, and frequency of selection and/or reporting: "pathophysiological manifestation" outcomes (n = 83) in 79% of articles; "growth and development" outcomes (n = 13) in 55% of articles; "death" outcomes (n = 3) and "life impact" outcomes (n = 17) in 39% and 37% of articles, respectively; "resource use" outcomes (n = 4) in 14%. Weight (50%), gastroesophageal reflux (35%), and site infection (25%) were the most frequently reported outcomes.

Limitations: We were unable to investigate effect size of outcomes because quantitative data were not collected.

Conclusions: The paucity of outcomes assessed for life impact, resource use and death hinders meaningful evidence synthesis. A COS could help overcome the current wide heterogeneity in selection and definition. These results will form the basis of a consensus process to produce a final COS.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Enteral Nutrition* / methods
  • Gastric Bypass*
  • Gastrostomy*
  • Humans
  • Infant
  • Infant, Newborn
  • Intubation, Gastrointestinal* / methods
  • Nervous System Diseases / therapy*
  • Outcome Assessment, Health Care / methods*

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