1
|
Rivero-Arias O, Buckell J, Knight M, Craig BM, Ramakrishnan R, Kenny S, Allin B. Defining treatment success in children with surgical conditions. Arch Dis Child 2024; 109:377-386. [PMID: 38135491 DOI: 10.1136/archdischild-2023-326156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Develop a score summarising how successfully a child with any surgical condition has been treated, and test the clinical validity of the score. DESIGN Discrete choice experiment (DCE), and secondary analysis of data from six UK-wide prospective cohort studies. PARTICIPANTS 253 people with lived experience of childhood surgical conditions, 114 health professionals caring for children with surgical conditions and 753 members of the general population completed the DCE. Data from 1383 children with surgical conditions were used in the secondary analysis. MAIN OUTCOME MEASURES Normalised importance value of attribute (NIVA) for number/type of operations, hospital-treated infections, quality of life and duration of survival (reference attribute). RESULTS Quality of life and duration of survival were the most important attributes in deciding whether a child had been successfully treated. Parents, carers and previously treated adults placed equal weight on both attributes (NIVA=0.996; 0.798 to 1.194). Healthcare professionals placed more weight on quality of life (NIVA=1.469; 0.950 to 1.987). The general population placed more weight on survival (NIVA=0.823; 95% CI 0.708 to 0.938). The resulting score (the Children's Surgery Outcome Reporting (CSOR) Treatment Success Score (TSS)) has the best possible value of 1, a value of 0 describes palliation and values less than 0 describe outcomes worse than palliation. CSOR TSSs varied clinically appropriately for infants whose data were included in the UK-wide cohort studies. CONCLUSIONS The CSOR TSS summarises how successfully children with surgical conditions have been treated, and can therefore be used to compare hospitals' observed and expected outcomes.
Collapse
Affiliation(s)
- Oliver Rivero-Arias
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK
- Nuffield Department of Population Health, Health Economics Research Centre (HERC), University of Oxford, Oxford, UK
| | - John Buckell
- Nuffield Department of Population Health, Health Economics Research Centre (HERC), University of Oxford, Oxford, UK
| | - Marian Knight
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK
| | - B M Craig
- Department of Economics, University of South Florida, Tampa, Florida, USA
| | - Rema Ramakrishnan
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK
| | - Simon Kenny
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Benjamin Allin
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK
- Chelsea and Westminster Hospital, London, UK
| |
Collapse
|
2
|
Ducey J, Lansdale N, Gorst S, Bray L, Teunissen N, Cullis P, Faulkner J, Gray V, Gutierrez Gammino L, Slater G, Baird L, Adams A, Brendel J, Donne A, Folaranmi E, Hopwood L, Long AM, Losty PD, Benscoter D, de Vos C, King S, Kovesi T, Krishnan U, Nah SA, Ong LY, Rutter M, Teague WJ, Zorn AM, Hall NJ, Thursfield R. Developing a core outcome set for the health outcomes for children and adults with congenital oesophageal atresia and/or tracheo-oesophageal fistula: OCELOT task group study protocol. BMJ Paediatr Open 2024; 8:e002262. [PMID: 38316469 PMCID: PMC10860107 DOI: 10.1136/bmjpo-2023-002262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/03/2023] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Heterogeneity in reported outcomes of infants with oesophageal atresia (OA) with or without tracheo-oesophageal fistula (TOF) prevents effective data pooling. Core outcome sets (COS) have been developed for many conditions to standardise outcome reporting, facilitate meta-analysis and improve the relevance of research for patients and families. Our aim is to develop an internationally-agreed, comprehensive COS for OA-TOF, relevant from birth through to transition and adulthood. METHODS AND ANALYSIS A long list of outcomes will be generated using (1) a systematic review of existing studies on OA-TOF and (2) qualitative research with children (patients), adults (patients) and families involving focus groups, semistructured interviews and self-reported outcome activity packs. A two-phase Delphi survey will then be completed by four key stakeholder groups: (1) patients (paediatric and adult); (2) families; (3) healthcare professionals; and (4) researchers. Phase I will include stakeholders individually rating the importance and relevance of each long-listed outcome using a 9-point Likert scale, with the option to suggest additional outcomes not already included. During phase II, stakeholders will review summarised results from phase I relative to their own initial score and then will be asked to rescore the outcome based on this information. Responses from phase II will be summarised using descriptive statistics and a predefined definition of consensus for inclusion or exclusion of outcomes. Following the Delphi process, stakeholder experts will be invited to review data at a consensus meeting and agree on a COS for OA-TOF. ETHICS AND DISSEMINATION Ethical approval was sought through the Health Research Authority via the Integrated Research Application System, registration no. 297026. However, approval was deemed not to be required, so study sponsorship and oversight were provided by Alder Hey Children's NHS Foundation Trust. The study has been prospectively registered with the COMET Initiative. The study will be published in an open access forum.
Collapse
Affiliation(s)
- Jonathan Ducey
- Department of Paediatric and Neonatal Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Nick Lansdale
- Department of Paediatric and Neonatal Surgery, Royal Manchester Children's Hospital, Manchester, UK
- Division of Developmental Biology and Medicine, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Sarah Gorst
- Department of Health Data Science, University of Liverpool, Liverpool, UK
- MRC/NIHR Trials Methodology Research Partnership, Liverpool, UK
| | - Lucy Bray
- Evidence-based Practice Research Centre, Edge Hill University, Ormskirk, UK
- Children's Nursing Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Nadine Teunissen
- Department of Pediatric Surgery, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, The Netherlands
| | - Paul Cullis
- Department of Paediatric and Neonatal Surgery, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Julia Faulkner
- Department of Dietetics, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | - Victoria Gray
- Department of Clinical Psychology, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
| | | | | | - Laura Baird
- Department of Speech and Language Therapy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Alex Adams
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Julia Brendel
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Adam Donne
- Department of ENT Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Eniola Folaranmi
- Department of Paediatric, Cardiff and Vale University Health Board, Cardiff, UK
| | - Laura Hopwood
- Department of Physiotherapy, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Anna-May Long
- Department of Paediatric and Neonatal Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Paul D Losty
- Department of Paediatric Surgery, Mahidol University, Salaya, Thailand
| | - Dan Benscoter
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Corné de Vos
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sebastian King
- Paediatric Surgery, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Tom Kovesi
- Pediatrics, Division of Respirology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Usha Krishnan
- Department of Pediatric Gastroenterology, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Shireen A Nah
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Lin Yin Ong
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Mike Rutter
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Warwick J Teague
- Department of Paediatric Surgery, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Aaron M Zorn
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Nigel J Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rebecca Thursfield
- Respiratory Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
3
|
Merritt RJ. Gastroschisis: Progress and Challenges. J Pediatr 2022; 243:8-11. [PMID: 34958830 DOI: 10.1016/j.jpeds.2021.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Russell J Merritt
- Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California.
| |
Collapse
|
4
|
Management of Gastroschisis: Results From the NETS2G Study, a Joint British, Irish, and Canadian Prospective Cohort Study of 1268 Infants. Ann Surg 2021; 273:1207-1214. [PMID: 33201118 DOI: 10.1097/sla.0000000000004217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In infants with gastroschisis, outcomes were compared between those where operative reduction and fascial closure were attempted ≤24 hours of age (PC), and those who underwent planned closure of their defect >24 hours of age following reduction with a pre-formed silo (SR). SUMMARY OF BACKGROUND DATA Inadequate evidence exists to determine how best to treat infants with gastroschisis. METHODS A secondary analysis was conducted of data collected 2006-2008 using the British Association of Pediatric Surgeons Congenital Anomalies Surveillance System, and 2005-2016 using the Canadian Pediatric Surgery Network.28-day outcomes were compared between infants undergoing PC and SR. Primary outcome was number of gastrointestinal complications. Interactions were investigated between infant characteristics and treatment to determine whether intervention effect varied in sub-groups of infants. RESULTS Data from 341 British and Irish infants (27%) and 927 Canadian infants (73%) were used. 671 infants (42%) underwent PC and 597 (37%) underwent SR. The effect of SR on outcome varied according to the presence/absence of intestinal perforation, intestinal matting and intestinal necrosis. In infants without these features, SR was associated with fewer gastrointestinal complications [aIRR 0.25 (95% CI 0.09-0.67, P = 0.006)], more operations [aIRR 1.40 (95% CI 1.22-1.60, P < 0.001)], more days PN [aIRR 1.08 (95% CI 1.03-1.13, P < 0.001)], and a higher infection risk [aOR 2.06 (95% CI 1.10-3.87, P = 0.025)]. In infants with these features, SR was associated with a greater number of operations [aIRR 1.30 (95% CI 1.17-1.45, P < 0.001)], and more days PN [aIRR 1.06 (95% CI 1.02-1.10, P = 0.003)]. CONCLUSIONS In infants without intestinal perforation, matting, or necrosis, the benefits of SR outweigh its drawbacks. In infants with these features, the opposite is true. Treatment choice should be based upon these features.
Collapse
|
5
|
Ferreira RG, Mendonça CR, Gonçalves Ramos LL, de Abreu Tacon FS, Naves do Amaral W, Ruano R. Gastroschisis: a systematic review of diagnosis, prognosis and treatment. J Matern Fetal Neonatal Med 2021; 35:6199-6212. [PMID: 33899664 DOI: 10.1080/14767058.2021.1909563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The present systematic review aims to investigate the diagnosis, prognosis, delivery assistance, pregnancy results and postnatal management in gastroschisis. STUDY DESIGN The following data sources were evaluated: The CINAHL, Embase and MEDLINE/PubMed databases were searched, observational and intervention studies published over the past 20 years. The quality of the studies was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). RESULTS A total of 3770 infants diagnosed with gastroschisis were included (44 studies); 1534 fetuses were classified as simple gastroschisis and 288 as complex gastroschisis. Intrauterine fetal demise occurred in 0.47% and elective termination occurred in 0.13%. Preterm delivery occurred in 23.23% and intrauterine growth restriction in 4.43%. Cesarean section delivery was performed in 54.6%. Neonatal survival was 91.29%. The main neonatal complications were: sepsis (11.78%), necrotizing enterocolitis (2.33%), short bowel syndrome (1.37%), bowel obstruction (0.79%), and volvulus (0.23%). Immediate surgical repair was performed in 80.1% with primary closure in 69%. The average to oral feeding was 33 (range: 11-124.5) days. Average hospital duration was 38 days and 89 days in neonates with simple and complex grastroschisis, respectively. CONCLUSIONS The present systematic review provides scientific data for counseling families with fetal gastroschisis.
Collapse
Affiliation(s)
- Rui Gilberto Ferreira
- Postgraduate program in Health Sciences, Universidade Federal de Goiás, Goiania, Brazil.,Department of Obstetrics and Gynaecology, Hospital das Clínicas, Universidade Federal de Goiás, Goiania, Brazil
| | | | | | | | - Waldemar Naves do Amaral
- Postgraduate program in Health Sciences, Universidade Federal de Goiás, Goiania, Brazil.,Department of Obstetrics and Gynaecology, Hospital das Clínicas, Universidade Federal de Goiás, Goiania, Brazil
| | - Rodrigo Ruano
- Department of Obstetrics and Gynecology, Pediatrics and Physiology, Division of Maternal-Fetal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| |
Collapse
|
6
|
Sutureless Approach for Gastroschisis Patients in Palestine. Case Rep Surg 2020; 2020:8732781. [PMID: 32908774 PMCID: PMC7463382 DOI: 10.1155/2020/8732781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/30/2020] [Accepted: 08/12/2020] [Indexed: 11/26/2022] Open
Abstract
Gastroschisis is a ventral abdominal wall congenital defect with bowel herniation outside the abdominal cavity. Gastroschisis traditional management is the primary operative closure surgery (POCS), but the sutureless silo approach (SSA), a novel alternative, gains wide acceptance in the developed countries and across nations. This study describes the first-ever gastroschisis patient managed with the sutureless silo approach in Palestine. In addition, we shall use this case as the very first nucleus for the upcoming gastroschisis management in our referral hospital because the SSA yields a reduced hospital stay which is fundamental to our institution due to the limited number of beds and lower management costs to the hospital and families.
Collapse
|
7
|
Wong M, Oron AP, Faino A, Stanford S, Stevens J, Crowell CS, Javid PJ. Variation in hospital costs for gastroschisis closure techniques. Am J Surg 2020; 219:764-768. [PMID: 32199604 DOI: 10.1016/j.amjsurg.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/28/2020] [Accepted: 03/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In newborns with gastroschisis, both primary repair and delayed fascial closure with initial silo placement are considered safe with similar outcomes although cost differences have not been explored. METHODS A retrospective review was performed of newborns admitted with gastroschisis at a single center from 2011 to 2016. Demographic, clinical, and cost data during the initial hospitalization were collected. Differences between procedure costs and clinical endpoints were analyzed using multivariable linear regression adjusting for prematurity, complicated gastroschisis, and performance of additional operations. RESULTS 80 patients with gastroschisis met inclusion criteria. Rates of primary fascial, primary umbilical cord closure, and delayed closure were 14%, 65%, and 21%, respectively. Delayed closure was associated with an increase in total hospital costs by 57% compared to primary repair (p < 0.001). In addition, delayed closure was associated with increased total and NICU LOS (p < 0.05), parenteral nutrition duration (p = 0.02), ventilator days (p < 0.001), time to goal enteral feeds (p = 0.01), and all cost sub-categories except ward room costs (p < 0.01). CONCLUSION Delayed fascial closure was associated with significantly greater hospital costs during the index admission.
Collapse
Affiliation(s)
- Melissa Wong
- University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Assaf P Oron
- Institute for Disease Modeling, Bellevue, WA, 98005, USA; Seattle Children's Research Institute, Seattle, WA, 98101, USA
| | - Anna Faino
- Seattle Children's Research Institute, Seattle, WA, 98101, USA
| | | | | | | | - Patrick J Javid
- University of Washington School of Medicine, Seattle, WA, 98195, USA; Seattle Children's Hospital, Seattle, WA, 98105, USA.
| |
Collapse
|
8
|
Abstract
OBJECTIVE Outcome reporting heterogeneity impedes identification of gold standard treatments for children born with gastroschisis. Use of core outcome sets (COSs) in research reduces outcome reporting heterogeneity and ensures that studies are relevant to patients. The aim of this study was to develop a gastroschisis COS. DESIGN AND SETTING Systematic reviews and stakeholder nomination were used to identify candidate outcomes that were subsequently prioritised by key stakeholders in a three-phase online Delphi process and face-to-face consensus meeting using a 9-point Likert scale. In phases two and three of the Delphi process, participants were shown graphical and numerical representations of their own, and all panels scores for each outcome respectively and asked to review their previous score in light of this information. Outcomes were carried forward to the consensus meeting if prioritised by two or three stakeholder panels in the third phase of the Delphi process. The COS was formed from outcomes where ≥70% of consensus meeting participants scored the outcome 7-9 and <15% of participants scored it 1-3. RESULTS 71 participants (84%) completed all phases of the Delphi process, during which 87 outcomes were assessed. Eight outcomes, mortality, sepsis, growth, number of operations, severe gastrointestinal complication, time on parenteral nutrition, liver disease and quality of life for the child, met criteria for inclusion in the COS. CONCLUSIONS Eight outcomes have been included in the gastroschisis COS as a result of their importance to key stakeholders. Implementing use of the COS will increase the potential for identification of gold standard treatments for the management of children born with gastroschisis.
Collapse
Affiliation(s)
| | - Nigel J Hall
- Southampton Children’s Hospital, Southampton, UK
| | | | | | | | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | | |
Collapse
|
9
|
Safety and usefulness of plastic closure in infants with gastroschisis: a systematic review and meta-analysis. Pediatr Surg Int 2019; 35:107-116. [PMID: 30392129 DOI: 10.1007/s00383-018-4381-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Recently, plastic closure of abdominal defect in infants with gastroschisis has been used. Timing of gastroschisis closure can be mainly divided into two groups: primary closure and delayed closure after silo forming. Safety and usefulness of plastic closure in gastroschisis remains unclear. We aimed to evaluate the current evidence for plastic closure in infants with gastroschisis. METHODS The analysis was done for primary closure as well as closure after silo. Outcomes were mortality, wound infection, duration of ventilation, time to feeding, and length of hospital stay (LOS). The quality of evidence was summarized using the GRADE approach. RESULTS In the "primary" group, there was no significant difference in mortality, time to feeding initiation and LOS. In the "silo" group, wound infection was significantly lower in plastic closure (Odds ratio 0.24, 95%CI 0.09-0.69, p = 0.008). Duration of ventilation, time to feeding initiation and LOS were significantly shorter after plastic closure (Ventilation; mean difference (MD) - 5.76, p = 0.03. Feeding initiation; MD - 9.42, p < 0.0001. LOS; MD - 14.06, p = 0.002). Quality of evidence was very low for all outcomes. CONCLUSIONS Current results suggest that plastic closure may be beneficial for infants with gastroschisis requiring silo formation. However, this evidence is suboptimal and further studies are needed.
Collapse
|
10
|
Hinton L, Locock L, Long AM, Knight M. What can make things better for parents when babies need abdominal surgery in their first year of life? A qualitative interview study in the UK. BMJ Open 2018; 8:e020921. [PMID: 29961020 PMCID: PMC6042569 DOI: 10.1136/bmjopen-2017-020921] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/29/2018] [Accepted: 05/24/2018] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To understand the experiences of parents of infants who required surgery early in life. To identify messages and training needs for the extended clinical teams caring for these families-including paediatric surgeons, neonatologists, nurses, obstetricians, midwives and sonographers. SETTING UK-wide interview study, including England, Wales and Scotland. PARTICIPANTS In-depth interviews were conducted with 44 parents who had a baby who underwent early abdominal surgery. Conditions included those diagnosed antenatally (eg, exomphalos, gastroschisis, congenital diaphragmatic hernia) or those which were detected postnatally (eg, Hirschsprung's disease, necrotising enterocolitis). Interviews were video and audio recorded and analysed using a modified grounded-theory approach. RESULTS While some parents reported experiencing excellent communication and felt they were listened to and involved by the care team, this was not always the case. Dealing with large, complex medical and surgical teams could result in conflicting messages, uncertainty and distress. Parents wanted information but also described being overwhelmed and wanting to distance themselves to maintain hope. Information and support from other parents in hospital and online groups were highly valued. Of particular concern was support when going home and caring for their baby after discharge; an open access policy for readmission offered a helpful safety net. CONCLUSIONS Listening to the experience of parents provides rich data to enhance clinical understandings on how to improve information and communication with parents, and ameliorate the deep and lasting distress and anxiety that some parents feel when their infants face early surgery. We suggest that the writings of Bourdieu could have resonance in interpreting the experiences of parents as they enter the world of highly technical neonatal medicine and surgery and the knowledge of the professionals who work in these environments.
Collapse
Affiliation(s)
- Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Louise Locock
- Health Service Research, University of Aberdeen, Aberdeen, UK
| | - Anna-May Long
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Marian Knight
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| |
Collapse
|
11
|
Haddock C, Al Maawali AG, Ting J, Bedford J, Afshar K, Skarsgard ED. Impact of Multidisciplinary Standardization of Care for Gastroschisis: Treatment, Outcomes, and Cost. J Pediatr Surg 2018; 53:892-897. [PMID: 29499843 DOI: 10.1016/j.jpedsurg.2018.02.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND/PURPOSE Elimination of unnecessary practice variation through standardization creates opportunities for improved outcomes and cost-effectiveness. A quality improvement (QI) initiative at our institution used evidence and consensus to standardize management of gastroschisis (GS) from birth to discharge. METHODS An interdisciplinary team utilized best practice evidence and expert opinion to standardize GS care. Following stakeholder engagement and education, care standardization was implemented in September 2014. A comparative cohort study was conducted on consecutive patients treated before (n=33) and after (n=24) standardization. Demographic, treatment, and outcome measures were collected from a prospective GS registry. Direct costs were estimated, and protocol compliance was audited. RESULTS BW, GA, and bowel injury severity were comparable between groups. Key practice changes were: closure technique (pre-88% primary fascial, post-83% umbilical cord flap; p<0.001), closure location (pre-97% OR, post-67% NICU; p<0.001), and GA avoidance (pre-0%, post-48%; p<0.001). Median post-closure ventilation days were shorter (pre-4, post-1; p<0.001), and SSI rates trended lower (pre-21%, post-8%; p=0.3) in the post-implementation group with no differences in TPN days or LOS. No significant difference was seen in average per-patient costs: pre-$85,725 ($29,974-221,061), post-$76,329 ($14,205-176,856). CONCLUSION Care standardization for GS enables practice transformation, cost-effective outcome improvement, and supports an organizational culture dedicated to continuous improvement. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Candace Haddock
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, University of British Columbia. Vancouver, BC, Canada
| | - Al Ghalgya Al Maawali
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, University of British Columbia. Vancouver, BC, Canada
| | - Joseph Ting
- Division of Neonatology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Julie Bedford
- Department of Quality and Safety, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Kourosh Afshar
- Division of Pediatric Urology, Department of Surgery, British Columbia Children's Hospital; Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Erik D Skarsgard
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, University of British Columbia. Vancouver, BC, Canada.
| |
Collapse
|
12
|
Gurien LA, Dassinger MS, Burford JM, Saylors ME, Smith SD. Does timing of gastroschisis repair matter? A comparison using the ACS NSQIP pediatric database. J Pediatr Surg 2017; 52:1751-1754. [PMID: 28408077 DOI: 10.1016/j.jpedsurg.2017.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/10/2017] [Accepted: 02/11/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is no consensus on optimal timing of gastroschisis repair. The 2012-2014 ACS NSQIP Pediatric Participant Use Data File was used to compare outcomes of primary versus staged gastroschisis repair. METHODS Cases were divided into primary repair (0-1day) and staged repair (4-14days). Baseline characteristics and outcomes were compared for primary versus staged closure using Fisher's exact tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. Length of stay was compared after controlling for prematurity. RESULTS There were 627 subjects included, with 364 neonates in the primary group and 263 in the staged group. The primary group demonstrated shorter hospital length of stay (LOS) (5.1days; p<0.001) and had less surgical site infections (OR=0.27; p=0.003), but had longer ventilator days (1.9days; p<0.001). Neonates in the primary repair group were less likely to be discharged home versus transferred to another hospital (OR=0.24; p=0.006) and more likely to require nutritional support at discharge (OR=1.74; p=0.034). No significant differences were identified for mortality, readmissions, postoperative LOS, sepsis or other outcomes. CONCLUSION Staged repair of gastroschisis has longer LOS attributed to preoperative timing, but less ventilator days. Outcomes for these closure techniques are equivocal and support surgeons performing the closure technique they are most experienced with. LEVEL OF EVIDENCE III (Treatment: retrospective comparative study).
Collapse
Affiliation(s)
- Lori A Gurien
- Department of Pediatric Surgery, Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR 72202, USA.
| | - Melvin S Dassinger
- Department of Pediatric Surgery, Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR 72202, USA
| | - Jeffrey M Burford
- Department of Pediatric Surgery, Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR 72202, USA
| | - Marie E Saylors
- Department of Biostatistics, Arkansas Children's Hospital Research Institute, 13 Children's Way, Little Rock, AR 72202, USA
| | - Samuel D Smith
- Department of Pediatric Surgery, Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR 72202, USA
| |
Collapse
|
13
|
Song YK, Lopez ON, Mehta HB, Bohanon FJ, Rojas-Khalil Y, Bowen-Jallow KA, Radhakrishnan RS. Race and outcomes in gastroschisis repair: a nationwide analysis. J Pediatr Surg 2017; 52:1755-1759. [PMID: 28365103 PMCID: PMC7772778 DOI: 10.1016/j.jpedsurg.2017.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 03/05/2017] [Accepted: 03/07/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND The incidence of gastroschisis has increased 30% between the periods 1995-2005 and 2006-2012, with the largest increase in Black neonates born to Black mothers younger than 20years old. OBJECTIVE Racial disparities in peri- and post-operative outcomes have been previously identified in several types of adult and pediatric surgical patients. Is there an association between race and clinical outcomes and healthcare resource utilization in neonates with gastroschisis? METHODS Retrospective study using national administrative data from the Kid's Inpatient Database (KID) from 2006, 2009, and 2012 for neonates (age<28days) with gastroschisis. Multivariable logistic regression was constructed to determine the association of race and socioeconomic characteristics with complications and mortality; linear regression was used for length of stay and hospital charges. RESULTS We identified 3846 neonates with gastroschisis that underwent surgical repair, including 676 patients with complex gastroschisis. When controlling for birth weight, payer status, socioeconomic status, and hospital characteristics, Black neonates had increased odds of having complex gastroschisis and associated atresias. Mortality was higher in patients with complex gastroschisis, patients from the lowest income quartiles, and patients with Medicaid as primary payer (compared to those with private insurance). Length of stay (LOS) was increased in patients with complex gastroschisis, birth weight <2500g, and Medicaid patients. Hospital charges were higher in complex gastroschisis, Black and Hispanic neonates (as compared to Whites), males, birth weight <2500g, and Medicaid patients. CONCLUSIONS There is an association between race and complex gastroschisis, associated intestinal atresias, and total charges in neonates with gastroschisis. In addition, income status is associated with mortality and hospital charges while payer status is associated with complications, mortality, LOS, and hospital charges. Public health and prenatal interventions should target at-risk populations to improve clinical outcomes. PROGNOSIS STUDY Level of Evidence: II.
Collapse
Affiliation(s)
- Ye Kyung Song
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Omar Nunez Lopez
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | | | | | | | | | - Ravi S. Radhakrishnan
- Department of Surgery, University of Texas Medical Branch, Galveston, TX,Department of Pediatrics, University of Texas Medical Branch, Galveston, TX,Corresponding author at: Department of Surgery, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0353. 409-772-5666, (R.S. Radhakrishnan)
| |
Collapse
|
14
|
de Oliveira GH, Svetliza J, Vaz-Oliani DCM, Liedtke H, Oliani AH, Pedreira DAL. Novel multidisciplinary approach to monitor and treat fetuses with gastroschisis using the Svetliza Reducibility Index and the EXIT-like procedure. EINSTEIN-SAO PAULO 2017; 15:395-402. [PMID: 29364360 PMCID: PMC5875150 DOI: 10.1590/s1679-45082017ao3979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 08/15/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe our initial experience with a novel approach to follow-up and treat gastroschisis in "zero minute" using the EXITlike procedure. METHODS Eleven fetuses with prenatal diagnosis of gastroschisis were evaluated. The Svetliza Reductibility Index was used to prospectively evaluate five cases, and six cases were used as historical controls. The Svetliza Reductibility Index consisted in dividing the real abdominal wall defect diameter by the larger intestinal loop to be fitted in such space. The EXIT-like procedure consists in planned cesarean section, fetal analgesia and return of the herniated viscera to the abdominal cavity before the baby can fill the intestines with air. No general anesthesia or uterine relaxation is needed. Exteriorized viscera reduction is performed while umbilical cord circulation is maintained. RESULTS Four of the five cases were performed with the EXIT-like procedure. Successful complete closure was achieved in three infants. The other cases were planned deliveries at term and treated by construction of a Silo. The average time to return the viscera in EXIT-like Group was 5.0 minutes, and, in all cases, oximetry was maintained within normal ranges. In the perinatal period, there were significant statistical differences in ventilation days required (p = 0.0169), duration of parenteral nutrition (p=0.0104) and duration of enteral feed (p=0.0294). CONCLUSION The Svetliza Reductibility Index and EXIT-like procedure could be new options to follow and treat gastroschisis, with significantly improved neonatal outcome in our unit. Further randomized studies are needed to evaluate this novel approach.
Collapse
Affiliation(s)
| | - Javier Svetliza
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | | | - Humberto Liedtke
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Antonio Helio Oliani
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | | |
Collapse
|
15
|
Cullis PS, Gudlaugsdottir K, Andrews J. A systematic review of the quality of conduct and reporting of systematic reviews and meta-analyses in paediatric surgery. PLoS One 2017; 12:e0175213. [PMID: 28384296 PMCID: PMC5383307 DOI: 10.1371/journal.pone.0175213] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 03/22/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Our objective was to evaluate quality of conduct and reporting of published systematic reviews and meta-analyses in paediatric surgery. We also aimed to identify characteristics predictive of review quality. BACKGROUND Systematic reviews summarise evidence by combining sources, but are potentially prone to bias. To counter this, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was published to aid in reporting. Similarly, the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) measurement tool was designed to appraise methodology. The paediatric surgical literature has seen an increasing number of reviews over the past decade, but quality has not been evaluated. METHODS Adhering to PRISMA guidelines, we performed a systematic review with a priori design to identify systematic reviews and meta-analyses of interventions in paediatric surgery. From 01/2010 to 06/2016, we searched: MEDLINE, EMBASE, Cochrane, Centre for Reviews and Dissemination, Web of Science, Google Scholar, reference lists and journals. Two reviewers independently selected studies and extracted data. We assessed conduct and reporting using AMSTAR and PRISMA. Scores were calculated as the sum of reported items. We also extracted author, journal and article characteristics, and used them in exploratory analysis to determine which variables predict quality. RESULTS 112 articles fulfilled eligibility criteria (53 systematic reviews; 59 meta-analyses). Overall, 68% AMSTAR and 56.8% PRISMA items were reported adequately. Poorest scores were identified with regards a priori design, inclusion of structured summaries, including the grey literature, citing excluded articles and evaluating bias. 13 reviews were pre-registered and 6 in PRISMA-endorsing journals. The following predicted quality in univariate analysis:, word count, Cochrane review, journal h-index, impact factor, journal endorses PRISMA, PRISMA adherence suggested in author guidance, article mentions PRISMA, review includes comparison of interventions and review registration. The latter three variables were significant in multivariate regression. CONCLUSIONS There are gaps in the conduct and reporting of systematic reviews in paediatric surgery. More endorsement by journals of the PRISMA guideline may improve review quality, and the dissemination of reliable evidence to paediatric clinicians.
Collapse
Affiliation(s)
- Paul Stephen Cullis
- Department of Surgical Paediatrics, Royal Hospital for Children, Glasgow, United Kingdom
- School of Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Katrin Gudlaugsdottir
- Department of Surgical Paediatrics, Royal Hospital for Children, Glasgow, United Kingdom
| | - James Andrews
- Department of Surgical Paediatrics, Royal Hospital for Children, Glasgow, United Kingdom
- School of Medicine, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
16
|
Abstract
We performed an evidence-based review of the obstetrical management of gastroschisis. Gastroschisis is an abdominal wall defect, which has increased in frequency in recent decades. There is variation of prevalence by ethnicity and several known maternal risk factors. Herniated intestinal loops lacking a covering membrane can be identified with prenatal ultrasonography, and maternal serum α-fetoprotein level is commonly elevated. Because of the increased risk for growth restriction, amniotic fluid abnormalities, and fetal demise, antenatal testing is generally recommended. While many studies have aimed to identify antenatal predictors of neonatal outcome, accurate prognosis remains challenging. Delivery by 37 weeks appears reasonable, with cesarean delivery reserved for obstetric indications. Postnatal surgical management includes primary surgical closure, staged reduction with silo, or sutureless umbilical closure. Overall prognosis is good with low long-term morbidity in the majority of cases, but approximately 15% of cases are very complex with complicated hospital course, extensive intestinal loss, and early childhood death.
Collapse
|
17
|
Allin BSR, Irvine A, Patni N, Knight M. Variability of outcome reporting in Hirschsprung's Disease and gastroschisis: a systematic review. Sci Rep 2016; 6:38969. [PMID: 27941923 PMCID: PMC5150519 DOI: 10.1038/srep38969] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 11/14/2016] [Indexed: 02/07/2023] Open
Abstract
Heterogeneity in outcome reporting limits identification of gold-standard treatments for Hirschsprung’s Disease(HD) and gastroschisis. This review aimed to identify which outcomes are currently investigated in HD and gastroschisis research so as to counter this heterogeneity through informing development of a core outcome set(COS). Two systematic reviews were conducted. Studies were eligible for inclusion if they compared surgical interventions for primary treatment of HD in review one, and gastroschisis in review two. Studies available only as abstracts were excluded from analysis of reporting transparency. Thirty-five HD studies were eligible for inclusion in the review, and 74 unique outcomes were investigated. The most commonly investigated was faecal incontinence (32 studies, 91%). Seven of the 28 assessed studies (25%) met all criteria for transparent outcome reporting. Thirty gastroschisis studies were eligible for inclusion in the review, and 62 unique outcomes were investigated. The most commonly investigated was length of stay (24 studies, 80%). None of the assessed studies met all criteria for transparent outcome reporting. This review demonstrates that heterogeneity in outcome reporting and a significant risk of reporting bias exist in HD and gastroschisis research. Development of a COS could counter these problems, and the outcome lists developed from this review could be used in that process.
Collapse
Affiliation(s)
- Benjamin Saul Raywood Allin
- National Perinatal Epidemiology Unit, Oxford, OX37LF, UK.,Department of Paediatric Surgery, Oxford Children's Hospital, Oxford, OX39DU, UK
| | - Amy Irvine
- University of Oxford Medical School Medical Sciences Divisional Office University of Oxford Level 3, John Radcliffe Hospital Oxford OX3 9DU, UK
| | - Nicholas Patni
- University of Oxford Medical School Medical Sciences Divisional Office University of Oxford Level 3, John Radcliffe Hospital Oxford OX3 9DU, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Oxford, OX37LF, UK
| |
Collapse
|
18
|
Cost modeling for management strategies of uncomplicated gastroschisis. J Surg Res 2016; 205:136-41. [DOI: 10.1016/j.jss.2016.06.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/14/2016] [Accepted: 06/10/2016] [Indexed: 11/21/2022]
|
19
|
Ross AR, Hall NJ. Outcome reporting in randomized controlled trials and systematic reviews of gastroschisis treatment: a systematic review. J Pediatr Surg 2016; 51:1385-9. [PMID: 27312236 DOI: 10.1016/j.jpedsurg.2016.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/16/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Core outcome sets (COS) facilitate clinical research by providing an agreed set of outcomes to be measured when evaluating treatment efficacy. Gastroschisis is increasing in frequency and evidence-based treatments are lacking. We aimed to identify initial candidate outcomes for a gastroschisis COS from existing literature. METHODS Using a sensitive search strategy we identified randomized controlled trials (RCTs) and systematic reviews (SRs) of treatment interventions for gastroschisis. Outcomes were extracted and assigned to the core areas, 'Pathophysiological Manifestations', 'Life Impact', 'Resource Use', 'Adverse Events' and 'Mortality'. RESULTS A total of 50 outcomes were identified. RCTs reported 6-9 outcomes each; SRs reported 9-25. The most frequently reported outcomes were 'Length of hospital stay' (reported in 8 studies), 'Duration of ventilation' and 'Time to full enteral feeds' (7 studies). Outcomes identified could be assigned to all five core areas. CONCLUSIONS There is wide heterogeneity in outcomes reported in studies evaluating treatment interventions for gastroschisis. It is unclear which outcomes are of highest importance across stakeholder groups. Developing a COS to standardize outcome measurement and reporting for gastroschisis is warranted.
Collapse
Affiliation(s)
- Andrew R Ross
- Department of Paediatric Surgery, Department of Paediatric Surgery, Jenny Lind Children's Hospital, Norfolk and Norwich, Norwich, UK
| | - Nigel J Hall
- Faculty of Medicine, University of Southampton, Southampton, UK; Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK.
| |
Collapse
|
20
|
Allin B, Ross A, Marven S, J Hall N, Knight M. Development of a core outcome set for use in determining the overall success of gastroschisis treatment. Trials 2016; 17:360. [PMID: 27465672 PMCID: PMC4964000 DOI: 10.1186/s13063-016-1453-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/01/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Gastroschisis research is limited in quality by the presence of significant heterogeneity in outcome measure reporting (PloS One 10(1):e0116908, 2015). Using core outcome sets in research is one proposed method for addressing this problem (Trials 13:103, 2012; Clin Rheumatol 33(9):1313-1322, 2014; Health Serv Res Policy 17(1):1-2, 2012). Ultimately, standardising outcome measure reporting will improve research quality and translate into improvements in patient care. METHODS/DESIGN Candidate outcome measures have been identified through systematic reviews. These outcome measures will form the starting point for an online, three-phase Delphi process that will be carried out in parallel by three panels of experts. Panel 1 is a neonatal panel, panel 2 is a non-neonatal panel and panel 3 is a lay panel. In round 1, experts will be asked to score the previously identified outcome measures from 1-9 based on how important they think the measures are in determining the overall success of their/their child's/their patient's gastroschisis treatment. In round 2, experts will be presented with the same list of outcome measures and with graphical representations of how their panel scored that outcome in round 1. They will be asked to re-score the outcome measure taking into account how important other members of their panel felt it to be. In round 3, experts will again be asked to re-score each outcome measure, but this time they will receive a graphical representation of the distribution of scores from all three panels which they should take into account when re-scoring. Following round 3 of the Delphi process, 40 experts will be invited to attend a face-to-face consensus meeting. Participants will be invited in a purposive manner to obtain balance between the different panels. The results of the Delphi process will be discussed, and outcomes re-scored. Outcome measures where > 70 % of the participants at the meeting scored them as 7-9 and < 15 % scored them as 1-3 will form the core outcome set. DISCUSSION Development of a core outcome set will help to reduce the heterogeneity of the outcome measure reporting in gastroschisis. This will increase the quality of research taking place and ultimately improve care provided to infants with gastroschisis.
Collapse
Affiliation(s)
- Benjamin Allin
- National Perinatal Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, England.
- Oxford University Hospitals NHS Trust, Headley Way, Headington, Oxford, OX3 9DU, England.
| | - Andrew Ross
- Oxford University Hospitals NHS Trust, Headley Way, Headington, Oxford, OX3 9DU, England
| | - Sean Marven
- Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, England
| | - Nigel J Hall
- Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, England
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, England
| |
Collapse
|
21
|
Allin B, Aveyard N, Campion-Smith T, Floyd E, Kimpton J, Swarbrick K, Williams E, Knight M. What Evidence Underlies Clinical Practice in Paediatric Surgery? A Systematic Review Assessing Choice of Study Design. PLoS One 2016; 11:e0150864. [PMID: 26959824 PMCID: PMC4784961 DOI: 10.1371/journal.pone.0150864] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/19/2016] [Indexed: 11/18/2022] Open
Abstract
Objective Identify every paediatric surgical article published in 1998 and every paediatric surgical article published in 2013, and determine which study designs were used and whether they were appropriate for robustly assessing interventions in surgical conditions. Methods A systematic review was conducted according to a pre-specified protocol (CRD42014007629), using EMBASE and Medline. Non-English language studies were excluded. Studies were included if meeting population criteria and either condition or intervention criteria. Population: Children under the age of 18, or adults who underwent intervention for a condition managed by paediatric surgeons when they were under 18 years of age. Condition: One managed by general paediatric surgeons. Intervention: Used for treatment of a condition managed by general paediatric surgeons. Main Outcome Measure Studies were classified according to whether the IDEAL collaboration recommended their design for assessing surgical interventions or not. Change in proportions between 1998 and 2013 was calculated. Results 1581 paediatric surgical articles were published in 1998, and 3453 in 2013. The most commonly used design, accounting for 45% of studies in 1998 and 46.8% in 2013, was the retrospective case series. Only 1.8% of studies were RCTs in 1998, and 1.9% in 2013. Overall, in 1998, 9.8% of studies used a recommended design. In 2013, 11.9% used a recommended design (proportion increase 2.3%, 95% confidence interval 0.5% increase to 4% increase, p = 0.017). Conclusions and Relevance A low proportion of published paediatric surgical manuscripts utilise a design that is recommended for assessing surgical interventions. RCTs represent fewer than 1 in 50 studies. In 2013, 88.1% of studies used a less robust design, suggesting the need for a new way of approaching paediatric surgical research.
Collapse
Affiliation(s)
- Benjamin Allin
- National Perinatal Epidemiology Unit, Oxford, United Kingdom
- Department of Paediatric Surgery, Oxford Children’s Hospital, Oxford, United Kingdom
- * E-mail:
| | | | | | - Eleanor Floyd
- Royal Berkshire Hospital NHS Trust, Reading, United Kingdom
| | - James Kimpton
- University of Oxford Medical School, Oxford, United Kingdom
| | - Kate Swarbrick
- Royal Berkshire Hospital NHS Trust, Reading, United Kingdom
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Emma Williams
- Royal Berkshire Hospital NHS Trust, Reading, United Kingdom
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Marian Knight
- National Perinatal Epidemiology Unit, Oxford, United Kingdom
| |
Collapse
|