Scenario

A 10-year-old boy seen in genetics clinic following a recent diagnosis of Marfan’s syndrome. The geneticist mentioned the use of prophylactic beta-blockers to reduce the risk of aortic dilatation. The boy’s mother is concerned about the prospect of taking daily medication from an early age and asks if this is necessary.

Structured clinical question

’Should beta-blockers (intervention) be commenced in all paediatric Marfan’s patients (patient) to prevent aortic dilation (outcome)?

Search

The Cochrane Library with the search terms ‘Marfan’s’ and ‘beta blockers’ yielded two reviews (one relevant) and three trials (two relevant).

EMBASE (All Resources) (Ovid)—(Marfan’s and (beta blocker or beta blockade or beta-blocker or beta-blockers) and (children or adolescent or paediatrics or adolescents or kids or child or paeds)).af.

Four hundred and sixty-five references were identified. Abstracts were screened for suitability. Studies in an exclusively adult population, those looking only at the biophysical properties of the aorta and those in animal models were excluded. This yielded 10 further papers.

PubMed—(MeSH ((Marfan’s) AND (beta blocker OR beta blocker OR beta blockade OR beta-blocker)) AND (children OR adolescent OR paediatrics OR adolescents OR kids OR child OR paeds).

Sixteen references …