Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 4 appraisals
European journal of pediatrics
Ambulatory hypertension and left ventricular hypertrophy in pediatric chronic kidney disease: a systematic review and meta-analysis
UNLABELLED: Cardiovascular disease is the leading cause of mortality in pediatric patients with chronic kidney disease (CKD). In the general pediatric population, hypertension is associated with an increased risk of left ventricular hypertrophy (LVH); however, the strength of this association varies in the pediatric CKD literature. A lack of consensus on optimal blood pressure (BP) targets for this population contributes to variability in clinical practice. This study aims to determine the association between ambulatory hypertension and LVH in pediatric CKD. A systematic literature search was conducted on five databases from 1974 to 2025. The mean left ventricular mass index (LVMI) and odds of LVH was compared between normotensive and hypertensive groups. The association between LVMI and 24-h systolic/diastolic blood pressure, day/night systolic/diastolic blood pressure, and 24-h mean arterial pressure (MAP), was determined. Fifty-one full text studies (n = 6509 children) were eligible for inclusion in the meta-analysis. Pediatric CKD patients with ambulatory hypertension demonstrated increased LVMI (mean difference 5.15 g/m2.7 (95% CI 3.16, 7.15) and increased risk of LVH odds ratio 2.82 (95% CI 2.18, 3.65) to normotensive controls. LVMI was significantly lower among children with a 24-h MAP < 50th percentile (- 8.2 g/m2.7, 95% CI - 16.0, - 0.4) and 24-h SBP between the 50 and 90th percentiles (- 10.8 g/m2.7, 95% CI - 20.8, - 0.8) compared to those with 24-h MAP or 24 h SBP > 90th percentile, respectively. CONCLUSION: In children with CKD, ambulatory hypertension is associated with elevated risk of LVH and increased LVMI. However, there was significant heterogeneity among the included studies with respect to study design and definition of outcomes. Timely detection of hypertensive target organ injury is imperative to mitigate future cardiovascular disease in pediatric CKD patients.Prospero Registration: CRD 42023426891. WHAT IS KNOWN: • Hypertension is a critical predictor of adverse cardiovascular outcomes in children with CKD. Hypertension-induced target organ damage such as LVH may predict future cardiovascular outcomes in high-risk populations. Despite this, there remains considerable variability in clinical blood pressure targets and monitoring practices. Our findings highlight the importance of ambulatory blood pressure monitoring (ABPM) in detecting subclinical cardiovascular injury, supporting its integration into routine CKD care to improve risk stratification and treatment decisions. WHAT IS NEW: • This meta-analysis establishes a robust association between ambulatory hypertension and left ventricular hypertrophy (LVH) in children with CKD, demonstrating that higher blood pressure burden is linked to increased left ventricular mass index (LVMI). Notably, children with 24-h mean arterial pressure (MAP) and systolic blood pressure (SBP) above the 90th percentile exhibited significantly greater LVMI, reinforcing the impact of sustained hypertension on cardiac remodelling in pediatric CKD. • The strong association between ambulatory hypertension and LVH underscores the urgent need for evidence-based BP thresholds that minimize cardiovascular risk in pediatric CKD. Early identification of hypertensive target organ damage may enable timely therapeutic interventions to prevent long-term cardiovascular complications. Future studies should focus on defining optimal BP targets and evaluating the efficacy of antihypertensive strategies tailored to pediatric CKD. Standardizing BP measurement approaches may further refine hypertension management and improve cardiovascular outcomes in this vulnerable population.
14 June 2026
Read appraisal →Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
The relation between cerebral arteriovenous malformations and heart diseases in the pediatric population: a systematic review and meta-analysis
Cerebral arteriovenous malformations (AVMs) and congenital heart diseases (CHDs) are rare, complex conditions that often present diagnostic and therapeutic challenges-especially when they coexist in pediatric patients. Though individually uncommon, their association raises important questions about shared developmental origins, systemic implications, and long-term outcomes. Understanding this relationship is crucial for improving early recognition, tailoring treatment strategies, and reducing morbidity and mortality in affected children. This systematic review and meta-analysis explored the relationship between AVMs and CHDs in the pediatric population, analyzing 139 studies published between 1971 and 2023. Together, these studies included data from 1042 patients. The co-occurrence of these two conditions highlights a potential interplay between cerebral and cardiac vascular development. By clarifying their association, this study aims to support earlier recognition, improve multidisciplinary management, and ultimately enhance clinical outcomes. The results revealed important patterns in how specific types and locations of AVMs relate to different forms of heart disease. AVMs located in infratentorial regions-such as the brainstem and cerebellum-were generally associated with lower risks of complications, while those in deep cerebral areas showed stronger links to adverse outcomes. Among the heart conditions evaluated, atrial septal defects (ASDs), cardiomyopathies, and high-output cardiac failure were most frequently associated with AVMs, suggesting overlapping embryologic and hemodynamic mechanisms. The most commonly reported complications included hydrocephalus, hemorrhage, and mortality. ROC curve analysis showed that mortality had the highest predictive value (AUC 0.62), followed by hydrocephalus (0.53) and hemorrhage (0.48). A composite risk model (AUC 0.59) suggested that combining clinical variables could improve prognostication. Neurological sequelae such as seizures, developmental delay, and microcephaly were frequent, particularly in hemorrhagic cases. Interestingly, in some patients, AVM treatment led to improvement in cardiac symptoms, suggesting a bidirectional relationship between cerebral and cardiac function. Despite variability in study quality, results were consistent across analyses, even when lower-quality studies were excluded. Most studies were rated moderate to high quality, though classification challenges were noted. Overall, the findings support a meaningful association between specific AVM and CHD subtypes and highlight the importance of early diagnosis and collaborative care involving multidisciplinary approach.
25 May 2026
Read appraisal →Current cardiology reports
Bridging Pediatric to Adult Care: A Scoping Review on Transitional Care for Individuals with Congenital Heart Disease Using Data Mining Techniques to Identify Key Topics
BACKGROUND: Adolescents and young adults with congenital heart disease (CHD) face significant challenges when transitioning from pediatric to adult care. Despite growing recognition of its importance, transitional care remains inconsistently implemented across healthcare systems, and a summary of published literature in this regard is still missing. This scoping review aims to systematically map the literature on CHD transitional care and identify key topics and trends. METHODS: Following Joanna Briggs Institute guidelines, we conducted a comprehensive search across seven electronic databases using the Population, Concept, and Context framework. A total of 73 studies were included. Data were extracted and analyzed using Latent Dirichlet Allocation to identify core topics, and Multiple Correspondence Analysis was applied to explore thematic relationships and validate topic structure. Lexicometric analysis assessed the linguistic complexity and specificity of the literature. RESULTS: Three major themes emerged: (1) Education, Self-Management, and Structured Support, (2) Timing, Knowledge Transfer, and Developmental Needs, and (3) Transition Program Implementation and Coordination. These themes reflect an increasing focus on structured educational strategies, developmentally tailored care, and system-level program delivery. Education-focused interventions were more frequently found in recent, high-quality experimental studies. In contrast, studies addressing timing and developmental needs and those focused on implementation were more common in earlier-phase or heterogeneous research contexts. CONCLUSION: Transitional care for individuals with CHD requires more standardized, evidence-based approaches. Improved documentation when reporting transitional care is essential to enhance fidelity, scalability, and long-term impact. This review provides a foundation for developing outcome-focused research and supports designing individualized, high-quality transition programs.
23 May 2026
Read appraisal →European journal of pediatrics
Predicting coronary artery abnormalities in Kawasaki disease: Model development and validation
Routine echocardiography at one month after diagnosis is the current standard for screening coronary artery abnormalities (CAA), a major complication of Kawasaki disease. The study aimed to develop and validate models to predict CAA and assess whether routine echocardiography could be safely reduced in low-risk patients. Two prospective multicenter Japanese registries were utilized: PEACOCK (development/internal validation) and Post-RAISE (external validation). Variables obtained within one week of diagnosis were used to predict CAA at one month after diagnosis, defined as a maximum coronary artery Z score (Zmax) ≥ 2. The models included simple models using the previous maximum Z score only, logistic regression models, and machine learning models (LightGBM and XGBoost). Discrimination, calibration, and clinical utility were assessed. Among 4,973 PEACOCK and 2,438 Post-RAISE patients, the CAA incidence was 5.5% and 6.8%, respectively. Twenty-two models were developed using 29 variables. For external validation, a simple model using the maximum Z score at week 1 produced an area under the curve (AUC) of 0.79; adding other variables or using more complex models did not increase the AUC by more than 0.02. The models failed to efficiently reduce the number of echocardiographic examinations while minimizing missed cased of CAA.Conclusion: Until superior predictors are identified, routine echocardiography at one month after diagnosis should remain the standard practice.
9 Apr 2026
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