An absence of pediatric randomized controlled trials in general medical journals, 1985-2004

Objective: There are numerous potential barriers to conducting randomized controlled trials (RCTs) in children. The purpose of this study was to compare the quantity, trends over time, characteristics, and quality of pediatric RCTs published in general medical journals (GMJs) with adult RCTs. Study Design and Setting: We conducted an electronic search of adult and pediatric RCTs from 1985-2004 and a manual search of published RCTs in the year 2000 in five high-impact GMJs (New England Journal of Medicine, Journal of the American Medical Association [JAMA], the Lancet, British Medical Journal [BMJ], Canadian Medical Association Journal [CMAJ]). Linear trends were identified and the 1-year sample was analyzed for publication characteristics (location of recruitment, sample size, number of centers, funding sources, and results) and quality scoring (Jadad score, intention-to-treat analysis, and citation frequency since publication). Results: Adult RCTs increased by 4.71 RCTs/year (95% confidence interval (CI) 3.62-5.80; P < 0.001), which was significantly higher (P < 0.0001) than pediatric RCTs, which increased by 0.4 RCTs/year (95% CI -0.02 to 0.9; P = 0.06). Adult RCTs were more likely to be hospital-based (P =.001) and to involve more centers in multicenter studies (P = 0.02). Quality scores were similar, although adult RCTs were cited more frequently (P = 0.003). Conclusion: There may be significant barriers to the publication of high-quality pediatric RCTs in GMJs. (c) 2007 Elsevier Inc. All rights reserved.