217 Systematic review PREMs allowed for the inclusion of different perspectives on PREM implementation from different countries. Despite being successful in identifying the number of pediatric PREMs currently in use, this review was not without limitations. Regarding gray literature, the information about the PREMs and their implementation were often not explicitly described on hospital websites, meaning we could only provide a global description of these PREMs. PREMs created in or translated to different languages or cultural contexts may have not been available in a language that the reviewers could understand, and therefore those studies were excluded. Furthermore, the inclusion criteria of “high-income countries” potentially limited the scope of this study by geographically restricting the results. Lastly, because of the interchangeable use of the terms “experience” and “satisfaction”, it is possible that due to the phrasing of study surveys, some PREMs were inadvertently excluded. However, the likelihood of this occurring was minimized due to the continual implementation of dual reviewers and the inclusion of the terms “satisfaction” and “satisfaction survey” in our initial search strategy. The objective of this systematic review was to identify pediatric PREMs and their use in care settings. Although there are tools like the COSMIN Checklist to critically appraise the validity and reliability of PROs (PROMs and PREMs), there are no such standard tools to evaluate the strengths and weaknesses of PREMs. Moreover, evaluating these measures for their strengths and weaknesses would be subjective and context specific. Therefore, this systematic review did not evaluate the strengths and weaknesses of the PREMs, but further studies focused on assessing the strengths and weaknesses of individual PREMs may be warranted in the future. Conclusion This systematic review details the international use of pediatric PREMs in different pediatric clinical settings and provides an overview of the current validated pediatric PREMs available for use. The findings of this review can guide health administrators and researchers to use appropriate PREMs to implement PFCC in pediatric settings. In most of the studies included in this review, the usefulness of pediatric PREMs was highlighted. However, future additional research into the views of implementing PREMs held by clinical practitioners and patients and their families is warranted to best gauge the practicality of widespread pediatric PREM implementation. 8
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