Factors Associated with Mortality Following Burns Complicated by Necrotizing Skin and Soft Tissue Infections: A Systematic Review and Meta-analysis of Individual Participant Data

Abstract We reviewed studies with individual participant data of patients who sustained burn injury and subsequently developed necrotizing skin and soft tissue infections (NSTI). Characteristics and managements were compared between patients who lived and patients who died to determine factors associated with mortality. Six databases (PubMed, EMBASE, Cochrane Library, Web of Science, Scopus and CINAHL) were searched. PRISMA-IPD guidelines were followed throughout the review. Eligible patients sustained a burn injury, treated in any setting, and diagnosed with a NSTI following burn injury. Comparisons were made between burned patients who lived “non-mortality” and burned patients who died “mortality” following NSTI using non-parametric univariate analyses. Fifty-eight studies with 78 patients were published from 1970 through 2019. Non-mortality resulted in 58 patients and mortality resulted in 20 patients. Patients with mortality had significantly greater median %TBSA burned (45%[IQR:44-64%] versus 35%[IQR:11-59%],p=0.033), more intubations (79% versus 43%,p=0.013), less debridements (83% versus 98%,p=0.039), less skin excisions (83% versus 98%,p=0.039), more complications (100% versus 50%,p<0.001), management at a burn center (100% versus 71%,p=0.008), underwent less flap surgeries (5% versus 35%,p=0.014), less graft survival (25% versus 86%,p<0.001), and less healed wounds (5% versus 95%,p<0.001), compared to patients with non-mortality, respectively. Non-mortality patients had more debridements, skin excised, systemic antimicrobials, skin graft survival, flaps, improvement following surgery and healed wounds compared to mortality patients. Mortality patients had greater %TBSA burned, intubations, management at a burn center and complications compared to non-mortality patients.

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Guided or self-guided internet-based cognitive–behavioural therapy (iCBT) for depression? Study protocol of an individual participant data network meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-026820 ◽

2019 ◽

Vol 9 (6) ◽

pp. e026820 ◽

Cited By ~ 2

Author(s):

Eirini Karyotaki ◽

Toshi A Furukawa ◽

Orestis Efthimiou ◽

Heleen Riper ◽

Pim Cuijpers

Keyword(s):

Cognitive Behavioural Therapy ◽

Meta Analysis ◽

Substantial Reduction ◽

Behavioural Therapy ◽

Cochrane Library ◽

Individual Participant Data ◽

Relative Efficacy ◽

Patient Level ◽

Cognitive Behavioural ◽

Individual Participant

IntroductionAlthough guided forms of internet-based cognitive–behavioural therapy (iCBT) result in a substantial reduction in depression, it seems that the most scalable way to deliver iCBT is without guidance. However, direct evidence on the comparison between guided and self-guided iCBT is scarce. Moreover, it is unclear which types of patients may benefit more from each of these two forms of iCBT. Network meta-analysis (NMA) using individual participant data (IPD) offers a way to assess the relative efficacy of multiple (>2) interventions. Moreover, it maximises our power to detect patient-level characteristics (covariates) that have an important effect on the efficacy of interventions. This protocol describes the procedures of an IPD-NMA, which aims at examining the relative efficacy of guided compared with self-guided iCBT and at identifying predictors and moderators of treatment outcome.Methods and analysisWe will use an existing database on psychotherapies for adult depression to identify eligible studies. This database has been updated up to 1 January 2018, through literature searches in PubMed, Embase, PsycINFO and Cochrane Library. The outcome of this IPD-NMA is reduction in depressive symptoms severity. We will fit the model in a Bayesian setting. After fitting the model, we will report the relative treatment effects for different types of patients, and we will discuss the clinical implications of our findings. Based on the results from the IPD-NMA model, we will develop and validate a personalised prediction model, aiming to provide patient-level predictions about the effects of the interventions.Ethics and disseminationAn ethical approval is not required for this study. The results will be published in a peer-review journal. These results will guide clinical decisions about the most efficient way to allocate iCBT resources, thereby increasing the scalability of this innovative therapeutic approach.

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Reducing Self-harm in Adolescents. An individual participant data meta-analysis (RISA-IPD): systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2021-049255 ◽

2021 ◽

Vol 11 (5) ◽

pp. e049255

Author(s):

Alexandra Wright-Hughes ◽

Rebecca Walwyn ◽

Judy M Wright ◽

Amanda Farrin ◽

Peter Fonagy ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Therapeutic Interventions ◽

Sensitivity Analyses ◽

Collaborative Group ◽

Cochrane Library ◽

Advisory Group ◽

Individual Participant Data ◽

Individual Participant ◽

Self Harm

IntroductionUp to 10% of adolescents report self-harm in the previous year. Non-fatal repetition is common (18% in 1 year), death from any cause shows a fourfold and suicide a 10-fold excess. Despite the scale of the problem, there is insufficient evidence for effective interventions for self-harm. Those who self-harm do so for a variety of different reasons. Different treatments may be more effective for subgroups of adolescents; however, little is known about which subgroups are appropriate for further study. This protocol outlines a systematic review and individual participant data meta-analysis (IPD-MA) to identify subgroups of adolescents for which therapeutic interventions for self-harm show some evidence of benefit.Methods and analysisA systematic literature search was conducted in August 2019 (including Cochrane Library, Embase, trial registers and other databases). An update search is planned. Study selection will identify randomised controlled trials examining interventions to reduce self-harm in adolescents who have self-harmed and presented to services. Identified research teams will be invited to contribute data and form a collaborative group. Two-stage IPD-MA will be used to evaluate effectiveness of different therapeutic interventions compared with any active or non-active control on repetition of self-harm, general psychopathology, depression, suicidal ideation, quality of life and death. Subgroup analyses will identify adolescent subgroups in whom different therapeutic interventions may be more effective. Meta-regression will explore moderating study and intervention effects. Sensitivity analyses will incorporate aggregate data from studies lacking IPD and test the robustness of results to methods for handling missing data, within-study clustering, non-adherence and study quality.Ethics and disseminationEthical approval is provided by the University of Leeds, Faculty of Medicine and Health Ethics Committee (18-098). Outcomes will inform research recommendations and will be disseminated internationally through the collaborative group, a service user advisory group, open-access peer-reviewed publication and conference presentations.PROSPERO registration numberCRD42019152119.

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Does maintenance azithromycin reduce asthma exacerbations? An individual participant data meta-analysis

European Respiratory Journal ◽

10.1183/13993003.01381-2019 ◽

2019 ◽

Vol 54 (5) ◽

pp. 1901381 ◽

Cited By ~ 5

Author(s):

Sarah A. Hiles ◽

Vanessa M. McDonald ◽

Michelle Guilhermino ◽

Guy G. Brusselle ◽

Peter G. Gibson

Keyword(s):

Severe Asthma ◽

Oral Corticosteroid ◽

Meta Analysis ◽

Emergency Department Visits ◽

Cochrane Library ◽

Individual Participant Data ◽

Double Blind ◽

Eosinophilic Asthma ◽

Long Term Treatment ◽

Individual Participant

BackgroundPreventing exacerbations is an important goal of asthma treatment. Long-term treatment with azithromycin may help achieve this. Our aim was to conduct a systematic review and individual participant data (IPD) meta-analysis to examine the efficacy of azithromycin in reducing exacerbations in asthma, and in the subphenotypes of noneosinophilic asthma, eosinophilic asthma and severe asthma.MethodWe completed a systematic search of Embase, MEDLINE, PubMed, Cochrane Library, ClinicalTrials.gov and reference lists of previous systematic reviews in February 2019. We included parallel-group, double-blind, randomised controlled trials in adults comparing at least 8 weeks of azithromycin treatment with placebo, where the outcome of exacerbations was assessed over at least 6 months. Data were extracted from published sources, Cochrane Risk of Bias Tool was applied and IPD were sought from authors. Reviews were undertaken in duplicate. We conducted an IPD meta-analysis on the primary outcome of exacerbations and a random effects meta-analysis for secondary outcomes.ResultsThree studies were identified (n=604). In the IPD meta-analysis, treatment with azithromycin was associated with a reduced rate of exacerbations (oral corticosteroid course due to worsening asthma, antibiotic use for lower respiratory tract infection, hospitalisation and/or emergency department visits) in asthma as well as in the noneosinophilic, eosinophilic and severe asthma subgroups. Examining each exacerbation type separately, patients with eosinophilic asthma reported fewer oral corticosteroid courses, and patients with noneosinophilic and severe asthma reported fewer antibiotic courses. Azithromycin was well tolerated.DiscussionMaintenance use of azithromycin reduces exacerbations in patients with eosinophilic, noneosinophilic and severe asthma.

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Comparing Kadish and Modified Dulguerov Staging Systems for Olfactory Neuroblastoma: An Individual Participant Data Meta-analysis

Otolaryngology ◽

10.1177/0194599820915487 ◽

2020 ◽

Vol 163 (3) ◽

pp. 418-427 ◽

Cited By ~ 1

Author(s):

Mark A. Arnold ◽

Soroush Farnoosh ◽

Mitchell R. Gore

Keyword(s):

Meta Analysis ◽

Olfactory Neuroblastoma ◽

Heterogeneous Group ◽

Superior Performance ◽

Cochrane Library ◽

Individual Participant Data ◽

Curative Intent ◽

Staging Systems ◽

Individual Participant ◽

The Impact

Objective To compare the Kadish and the modified Dulguerov staging of individual participants to determine the impact of stage and other prognostic factors on disease-free (DFS) and overall survival (OS). Data Sources Systematic review of EMBASE, MEDLINE, Cochrane Library, and CINAHL databases. Review Methods The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) was followed for this study. Articles including patients with olfactory neuroblastoma (ONB) staged with both Kadish and Dulguerov staging systems were reviewed. The raw data from eligible studies were requested to perform an individual participant data (IPD) meta-analysis. Results Pooled data from 21 studies representing 399 patients with ONB undergoing treatment with curative intent showed that increasing age, treatment with chemotherapy, and positive or unreported margin status portended worse DFS ( P < .05). Increasing stage for both Kadish and Dulguerov staging systems was prognostic for worse DFS and OS ( P < .05), with Kadish C representing a heterogeneous group with regard to outcome and corresponding Dulguerov T stage. Using the Akaike information criterion, the Dulguerov staging system had superior performance to the Kadish system for DFS (1088.72 vs 1092.54) and OS (632.71 vs 644.23). Conclusion This study represents the first IPD meta-analysis of ONB directly comparing the outcomes of Kadish and Dulguerov staging systems in patients treated with primary surgery. Both systems correlated with DFS and OS, with superior performance in the Dulguerov system. Furthermore, the Kadish C group represented a heterogeneous group with regard to outcomes after stratification by the Dulguerov system. Dulguerov T4 patients had the worst outcome, with most being approached with open resection.

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Efficacy and safety of linezolid compared with other treatments for skin and soft tissue infections: a meta-analysis

Bioscience Reports ◽

10.1042/bsr20171125 ◽

2018 ◽

Vol 38 (1) ◽

Cited By ~ 3

Author(s):

Yan Li ◽

Wei Xu

Keyword(s):

Soft Tissue ◽

Confidence Interval ◽

Risk Ratio ◽

Meta Analysis ◽

Cochrane Library ◽

Soft Tissue Infections ◽

Efficacy And Safety ◽

Significant Difference ◽

Cure Rates ◽

Microbiological Cure

Linezolid with other treatments for skin and soft tissue infections (SSTIs) has been evaluated in several studies. However, the conclusions remain controversial. By searching PubMed, EMBASE, and Cochrane library databases, we conducted a meta-analysis to evaluate linezolid and other treatments for skin and soft tissue infections. The study was summarized, and the risk ratio (RR) and its 95% confidence interval (CI) were calculated. Eleven related articles were included in the meta-analysis. Our results revealed that linezolid was associated with a significantly better clinical (RR = 1.09, 95% CI: 1.02–1.16, Pheterogeneity = 0.326, I2 = 13.0%) and microbiological cure rates (RR = 1.08, 95% CI: 1.01–1.16, Pheterogeneity = 0.089, I2 = 41.7%) when comparing with vancomycin. There was no significant difference in the incidence of anemia, nausea, and mortality; however, the incidence of vomiting, diarrhea, and thrombocytopenia in patients treated with linezolid is significantly higher than that with other treatments. Our study confirmed that linezolid seems to be more effective than vancomycin for treating people with SSTIs. It is recommended that linezolid be monitored for thrombocytopenia, vomiting, and diarrhea. Further studies with larger dataset and well-designed models are required to validate our findings.

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Identifying predictors of response to oral non-steroidal anti-inflammatory drugs and paracetamol in osteoarthritis: a hypothesis-driven protocol for an OA Trial Bank individual participant data meta-analysis

BMJ Open ◽

10.1136/bmjopen-2021-048652 ◽

2021 ◽

Vol 11 (8) ◽

pp. e048652

Author(s):

Yilin Xiong ◽

Chao Zeng ◽

Michael Doherty ◽

Monica S M Persson ◽

Jie Wei ◽

...

Keyword(s):

Risk Factors ◽

Meta Analysis ◽

Joint Inflammation ◽

Cochrane Library ◽

Controlled Trials ◽

Individual Participant Data ◽

Effect Change ◽

Individual Participant ◽

Inflammatory Drugs ◽

Anti Inflammatory

IntroductionSymptomatic treatments for osteoarthritis (OA) provide only small-to-moderate efficacy over placebo in randomised controlled trials (RCTs). Treatment guidelines therefore have emphasised the need to identify predictors of treatment response through subgroup and multiple regression analysis. Individual participant data (IPD) meta-analysis is recommended as an efficient approach for this purpose. To our knowledge, this has not been undertaken for oral non-steroidal anti-inflammatory drugs (NSAIDs), including paracetamol, in OA. In this IPD meta-analysis, we aim to identify RCTs with specific mechanistic features related to OA pain, such as joint inflammation. We hypothesise that NSAIDs may work better for participants with joint inflammation, whereas paracetamol may not.Methods and analysisA comprehensive literature search will be conducted on the databases of Web of Science, Embase, Medline, CINAHL, AMED and the Cochrane Library from 1 January 1998 to 1 December 2020. All RCTs related to oral NSAIDs or paracetamol including placebo-controlled trials in people with OA that have evaluated pain-related peripheral risk factors (eg, clinically detected knee effusion, synovial hypertrophy or effusion on imaging, knee morning stiffness, elevated serum C-reactive protein (CRP) level) and/or central pain risk factors (eg, pain elsewhere, depression, anxiety, sleep disturbance) will be retrieved. The outcome will be change in pain from baseline. Change in function and patient global assessment will also be included as outcomes if available. Investigators of all eligible trials will be contacted for IPD. Multilevel regression models will be used to identify predictors for the specific (active–placebo) and the overall treatment effect (change from baseline in active group).Ethics and disseminationNo identifiable data will be included in this study and no formal ethics approval is required as no new data collection will be processed. Results of this hypothesis-driven IPD meta-analysis will be disseminated through conference presentations and publication in peer-reviewed journals.PROSPERO registration numberCRD42020165098.

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