scholarly journals Meta-Analysis of Functional Outcomes in 5508 Patients Sustaining a Gunshot Wound to the Head

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Georgios Maragkos ◽  
Efstathios Papavassiliou ◽  
Martina Stippler ◽  
Aristotelis Filippidis
Keyword(s):  
Cohort Studies ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Gunshot Wounds ◽  
Clinical Decision ◽  
Pupillary Response ◽  
Random Effects Models

Abstract INTRODUCTION There is currently no consensus regarding prognosis and management for gunshot wounds to the head (GSWH). To the author’' knowledge, this is the first meta-analysis to study functional outcomes in GSWH. METHODS Five online databases and the reference lists of relevant articles were queried for cohort studies of GSWH reporting factors associated with functional outcome. PRISMA guidelines were followed. Study quality was assessed using the Newcastle–Ottawa scale. Glasgow Outcome Scale (GOS) outcomes were divided into unfavorable (GOS 1-3) and favorable (GOS 4-5). Pooled estimates of odds ratios and 95% confidence intervals were derived using random-effects models. Heterogeneity was assessed with I-square and meta-regression. Funnel-plots were utilized to assess publication bias. RESULTS We identified 35 retrospective cohort studies encompassing 5508 GSWH patients. Out of the factors assessed, the ones significantly associated with unfavorable functional outcome were: postresuscitation GCS 3 to 8 (Odds Ratio 33.2, 95% Confidence Interval [10.1-108.6]), suicide attempt (3.6 [1.7-7.8]), penetration of the dura (10.3 [1.8-60.5]), bullet trajectory through both hemispheres (8.3 [4.1-17.2]), through the ventricles (8.8 [1.6-48.8]), and through multiple lobes (8.6 [2.2-33.5]). No statistical significance was found for unfavorable functional outcome regarding patient age, sex, pupillary response, and the existence of an exit wound. CONCLUSION This is the first systematic review and meta-analysis regarding prognostic factors for neurologic outcomes in patients sustaining GSWH. Such factors can inform clinical decision-making and assist in setting patient and physician expectations in the acute setting. Further research is required to properly incorporate this information into management guidelines.

scholarly journals Meta-analyses in paediatric surgery are often fragile: implications and consequences

2021 ◽  
Vol 37 (3) ◽  
pp. 363-367
Author(s):  
Arne Schröder ◽  
Oliver J. Muensterer ◽  
Christina Oetzmann von Sochaczewski
Keyword(s):  
Clinical Decision Making ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Clinical Decision ◽  
Paediatric Surgery ◽  
Fragility Index ◽  
Level Of Evidence ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
Surgical Condition

Abstract Purpose Meta-analyses occupy the highest level of evidence and thereby guide clinical decision-making. Recently, randomised-controlled trials were evaluated for the robustness of their findings by calculating the fragility index. The fragility index is the number of events that needs to be added to one treatment arm until the statistical significance collapses. We, therefore, aimed to evaluate the robustness of paediatric surgical meta-analyses. Methods We searched MEDLINE for paediatric surgical meta-analyses in the last decade. All meta-analyses on a paediatric surgical condition were eligible for analysis if they based their conclusion on a statistically significant meta-analysis. Results We screened 303 records and conducted a full-text evaluation of 60 manuscripts. Of them, 39 were included in our analysis that conducted 79 individual meta-analyses with significant results. Median fragility index was 5 (Q25–Q75% 2–11). Median fragility in relation to included patients was 0.77% (Q25–Q75% 0.29–1.87%). Conclusion Paediatric surgical meta-analyses are often fragile. In almost 60% of results, the statistical significance depends on less than 1% of the included population. However, as the fragility index is just a transformation of the P value, it basically conveys the same information in a different format. It therefore should be avoided.

Abstract P111: Comparative Efficacy Of Bisoprolol Compared To Other Selective Beta-1 Blockers In Patients With Hypertension - A Systematic Review And Meta-analysis Of Observational Studies

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Uday M Jadhav ◽  
Tiny Nair ◽  
SANDEEP BANSAL ◽  
Saumitra Ray
Keyword(s):  
Lipid Profile ◽  
Observational Studies ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Hdl Cholesterol ◽  
Clinical Decision ◽  
Cochrane Library ◽  
Favourable Effect ◽  
Pooled Data ◽  
Cholesterol Levels

Introduction: Selective beta-1 blockers (s-BBs) are used in the management of hypertension (HT) in specific subsets. Studies comparing the potency of blood pressure (BP) lowering with different s-BBs are sparse. The objective of this meta-analysis was to evaluate the efficacy of bisoprolol compared to other s-BBs (Atenolol, Betaxolol, Esmolol, Acebutolol, Metoprolol, Nebivolol) in HT patients by examining their effect on BP, heart rate (HR) and metabolic derangements, by examining the evidences reported in observational studies. Methods: Electronic databases like PubMed, EMBASE, Cochrane Library, Clinicaltrials.gov, Surveillance, Epidemiology and End Results Program and 12 PV databases were systematically searched from inception to October 2019. Observational studies that compared bisoprolol with other s-BBs in patients with HT were evaluated in accordance with the PRISMA guidelines. Pooled data were calculated using random-effects model for meta-analysis in terms of mean difference (MD) and 95% confidence interval (95% CI) for each outcome. Outcomes of interest were BP, HR and lipid profile. Results: Four observational studies which compared bisoprolol with other s-BBs (nebivolol and atenolol) were included in this meta-analysis. Significant reduction was observed in office diastolic BP [MD: -1.70; 95% CI: -2.68,-0.72; P <0.01] among arterial HT patients treated with bisoprolol for 26 weeks (w) compared to those treated with other s-BBs. HT patients treated with bisoprolol for 26 w showed significant reduction in HR [MD: -2.20; 95% CI: -3.57,-0.65; P <0.01] and office HR [MD: -2.55; 95% CI: -3.57,-1.53; P <0.01] than other s-BBs. HDL cholesterol levels increased significantly in essential HT patients treated with bisoprolol at 26 w [MD: 7.17; 95% CI: 1.90,12.45; P <0.01], 78 w [MD: 11.70; 95% CI: 4.49,18.91; P <0.01] and 104 w [MD: 10.20, 95% CI: 4.49,18.91; P <0.01] compared to other s-BBs. Conclusion: Our results suggests that bisoprolol is superior to other s-BBs in reducing BP and HR. Bisoprolol also had a favourable effect on lipid profile shown by increase in HDL cholesterol. This meta-analysis emphasizes the efficacy of bisoprolol over other s-BBs, which aids clinical decision making in treatment of patients with HT.

Functional Outcomes After Fracture-Dislocation of the Ankle

2019 ◽  
Vol 13 (1) ◽  
pp. 18-26 ◽  
Author(s):  
Direk Tantigate ◽  
Gavin Ho ◽  
Joshua Kirschenbaum ◽  
Henrik C. Bäcker ◽  
Benjamin Asherman ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Ankle Fracture ◽  
Statistical Significance ◽  
Ankle Fractures ◽  
Fracture Dislocation ◽  
Wound Complications ◽  
Pain Subscale ◽  
Fracture Dislocations

Background. Fracture dislocation of the ankle represents a substantial injury to the bony and soft tissue structures of the ankle. There has been only limited reporting of functional outcome of ankle fracture-dislocations. This study aimed to compare functional outcome after open reduction internal fixation in ankle fractures with and without dislocation. Methods. A retrospective chart review of surgically treated ankle fractures over a 3- year period was performed. Demographic data, type of fracture, operative time and complications were recorded. Of 118 patients eligible for analysis, 33 (28%) sustained a fracture-dislocation. Mean patient age was 46.6 years; 62 patients, who had follow-up of at least 12 months, were analyzed for functional outcome assessed by the Foot and Ankle Outcome Score (FAOS). The median follow-up time was 37 months. Demographic variables and FAOS were compared between ankle fractures with and without dislocation. Results. The average age of patients sustaining fracture-dislocation was greater (53 vs 44 years, P = .017); a greater percentage were female (72.7% vs 51.8%, P = .039) and diabetic (24.2% vs 7.1%, P = .010). Wound complications were similar between both groups. FAOS was generally poorer in the fracture-dislocation group, although only the pain subscale demonstrated statistical significance (76 vs 92, P = .012). Conclusion. Ankle fracture-dislocation occurred more frequently in patients who were older, female, and diabetic. At a median of just > 3-year follow-up, functional outcomes in fracture-dislocations were generally poorer; the pain subscale of FAOS was worse in a statistically significant fashion. Levels of Evidence: Therapeutic, Level III

A meta-analysis of confidence and judgment accuracy in clinical decision making.

2015 ◽  
Vol 62 (4) ◽  
pp. 553-567 ◽  
Author(s):  
Deborah J. Miller ◽  
Elliot S. Spengler ◽  
Paul M. Spengler
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Judgment Accuracy

scholarly journals Pregnancy-related complications and incidence of atrial fibrillation: a systematic review and meta-analysis

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
T Al Bahhawi ◽  
A Aqeeli ◽  
S L Harrison ◽  
D A Lane ◽  
I Buchan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Cohort Studies ◽  
Observational Studies ◽  
Large Scale ◽  
Data Extraction ◽  
Meta Analysis ◽  
Significant Heterogeneity ◽  
Random Effects Models ◽  
Increased Risk

Abstract Funding Acknowledgements Type of funding sources: None. Background Pregnancy-related complications have been previously associated with incident cardiovascular disease. However, data are scarce on the association between pregnancy-related complications and incident atrial fibrillation (AF). This systematic review examines associations between pregnancy-related complications and incident AF. Methods A systematic search of the literature utilising MEDLINE and EMBASE (Ovid) was conducted from 1990 to 6 April 2020. Observational studies examining the association between pregnancy-related complications including hypertensive disorders of pregnancy (HDP), gestational diabetes, placental abruption, preterm birth, low birth weight, small-for-gestational-age and stillbirth, and incidence of AF were included. Screening and data extraction were conducted independently by two reviewers. Inverse-variance random-effects models were used to pool hazard ratios. Results: Six observational studies met the inclusion criteria one case-control study and five retrospective cohort studies, with four studies eligible for meta-analysis.  Sample sizes ranged from 1,839-1,303,365. Mean/median follow-up for the cohort studies ranged from 7-36 years. Most studies reported an increased risk of incident AF associated with pregnancy-related complications. The pooled summary statistic from four studies reflected a greater risk of incident AF for HDP (hazard ratio (HR) 1.47, 95% confidence intervals (CI) 1.18-1.84; I2 = 84%) and from three studies for pre-eclampsia (HR 1.71, 95% CI 1.41-2.06; I2 = 64%; Figure). Conclusions The results of this review suggest that pregnancy-related complications particularly pre-eclampsia appear to be associated with higher risk of incident AF. The small number of included studies and the significant heterogeneity in the pooled results suggest further large-scale prospective studies are required to confirm the association between pregnancy-related complications and AF. Abstract Figure.

Abstract WP331: Does Successful Reperfusion Mean Successful Outcome in Elderly Stroke Patients?

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Amber N Ruiz ◽  
Agnelio Cardentey ◽  
WT Longstreth ◽  
David L Tirschwell ◽  
Claire J Creudtzfeldt
Keyword(s):  
Elderly Patients ◽  
Functional Outcome ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Successful Outcome ◽  
Good Outcome ◽  
Single Center Experience ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Randomized clinical trials (RCTs) suggest a benefit of mechanical thrombectomy (MT) even for individuals ≥ 80 years of age; however, this population has not been consistently included in RCTs, and the eldest (≥85 years) are underrepresented. Small observational studies suggest that elderly patients experience a higher proportion of in-hospital complications, mortality, and poor functional outcome defined as modified Rankin Scale Score (mRS) ≥4. While MT is generally recommended in this population, little is known about how decisions are made to undergo MT or subsequently to withdraw or withhold life-sustaining treatments (WoLST). The goal of this study was to describe a single center experience of elderly patients who underwent MT. Methods: We identified all patients admitted to our comprehensive stroke center from June 2016 - June 2018 who were ≥85 years old and underwent successful MT, defined as TICI 2a to 3. We collected data from the electronic medical record, including WoLST. A good outcome was defined as a mRS of 0-2 at 90 days. Results: We identified a total of 29 patients with successful MT with a mean age of 88.4 years (SD=3.6); 66% were women. Only one patient (3.4%) achieved a good outcome, while 65.5% died (see figure). Among decedents, 47.4% expired during their initial hospitalization, while 15.8% were discharged to hospice. A decision for WoLST was made in 11 patients, 88.9% of in-hospital decedents. Discussion: In our retrospective study of 29 elderly patients who underwent successful MT, only one achieved good functional outcome, and most died in the setting of WoLST. These observations may raise the question about the appropriateness of MT in this cohort, emphasizing the need for further research aimed (1) to identify determinants of outcome and MT success specific to elderly MT candidates and (2) to better understand the process of clinical decision making for this growing, vulnerable population of elderly patients.

Dynamic Hip Screw versus Proximal Femoral Nail in the Management of Intertrochanteric Fractures - A Retrospective Analysis from Rajasthan

2021 ◽  
Vol 8 (26) ◽  
pp. 2271-2277
Author(s):  
Gajanand Shriram Dhaked ◽  
Abhishek Komalsingh Jaroli ◽  
Khushboo Parmanand Malav ◽  
Harish Narayan Singh Rajpurohit
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Statistical Significance ◽  
Dynamic Hip Screw ◽  
Proximal Femoral Nail ◽  
Final Decision ◽  
Intertrochanteric Fractures ◽  
Femoral Nail ◽  
Duration Of Surgery ◽  
Hip Screw

BACKGROUND Current management of Intertrochanteric (IT) fractures has evolved with the introduction of dynamic hip screw (DHS) and proximal femoral nail (PFN). The purpose of this study was to compare the functional outcomes between the DHS and PFN for IT fracture fixation. METHODS This study is a retrospective comparative analysis of 455 patients with IT fractures; DHS (292) and PFN (163), who were treated from June 2012 to June 2015. The patients were reviewed postoperatively for a minimum of 12 months to evaluate functional outcome using Salvati-Wilson score. Categorical data was present as absolute number or percentages, and parametric variables were presented as Mean ± SD, while non parametric data were presented as median. Statistical significance was defined as P < 0.05. RESULTS Intramedullary nails offer no advantage over extramedullary devices to treat IT fractures caused by low-energy trauma (AO 31 - A1). However, clinically significant outcomes were established for PFN group in terms of duration of surgery, x- ray exposure and SW Score for AO / OTA 31 - A2 and 31 - A3. Reoperations encountered for local pain due to implant prominence were significantly higher in the PFN group (4.90 % versus 1.02 %). Kaplan Meier survival probability of 69.3 % and 79.5 % predicted for DHS and PFN respectively, 3 years postoperatively. CONCLUSIONS Our conclusion reinforces indication for PFN in unstable IT fractures (31 - A2 and 31 - A3), owing to its better functional outcome and biomechanical properties. Functional outcomes for stable IT fracture (AO 31 - A1) were comparable between DHS and PFN, therefore final decision for implant choice depends on implant cost, surgeon’s preference for specific technique. However, understanding the morphology of proximal femur, peritrochanteric region is crucial to analyse the anatomical variations in Indian population which will provide the basis for intramedullary nail design modifications. KEYWORDS Intertrochanteric Fractures, DHS Fixation, PFN Fixation

Abstract WP65: Low-Versus Standard-Dose Alteplase for AcuteIschemic Strokes Within 4.5 Hours: An updated Meta Analysis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Huaguang Zheng ◽  
Xu Tong ◽  
Liping Liu ◽  
Zixiao Li ◽  
Xiaoling Liao ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Random Effects ◽  
Standard Dose ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Tissue Type ◽  
Random Effects Models ◽  
Dose Treatment ◽  
Randomized Controlled ◽  
Type Plasminogen Activator

Background and Purpose: We performed a meta-analysis to compare the outcomes between lower dose and standard dose intravenous tissue-type plasminogen activator (tPA) for acute ischemic stroke in randomized and non- randomized controlled trials. Methods: We searched PubMed for relevant studies and calculated pooled odds ratios (ORs) using random effects models.The primary endpoint was good functional outcome[modified Rankin Scale (mRS) of 0-1] at 3 month after stroke onset. Other major end points were all-cause mortality and symptomatic intracerebral haemorrhage (sICH). Results: From 2010 to 2016, 7 Cohort studies and 1 randomized controlled trial (ENCHANTED trial) were pooled in meta-analysis. The lower tPA strategy was likely to be less effective than the standard dose treatment (OR=0.87; 95% confidence interval [CI], 0.73-1.04, P=0.136; I 2 =47.9%, P=0.044 in random effects models and OR=0.88; 95% CI 0.88-0.98,P=0.016 ;I 2 =0.0%, P=0.693 in non- random effects models after 2 cohort studies were excluded due to heterogeneity). No difference was found for mortality at 90 days (OR=0.87; 95% CI 0.74-1.03, P=0.102 ;I 2 =0.0%, P=0.635 in non-random effects models)and sICH (OR=1.12; 95% CI 0.68-1.83,P=0.659; I 2 =57.6%, P=0.016 in random effects models and OR=1.23; 95% CI 0.92-1.65, P=0.168; I 2 =0.0%, P=0.547 in non-random effects models after 2 cohort studies were excluded due to heterogeneity ) between lower tPA group and standard dose . Conclusions: The low-dose alteplase strategy was less effective comparable to the standard-dose treatment .The safety was similar between the two strategies.

P1858Meta-analysis of performance of risks scores for predicting outcomes after percutaneous Mitraclip implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T K M Wang ◽  
M T M Wang
Keyword(s):  
Confidence Interval ◽  
Risk Stratification ◽  
Clinical Decision Making ◽  
Operative Mortality ◽  
Data Extraction ◽  
Meta Analysis ◽  
Critical Role ◽  
Clinical Decision ◽  
Risk Scores ◽  
Sts Score

Abstract Background The Mitraclip is the most established percutaneous mitral valve intervention indicated for severe mitral regurgitation at high or prohibitive surgical risk. Risk stratification plays a critical role in selecting the appropriate treatment modality in high risk valve disease patients but have been rarely studied in this setting. We compared the performance of risk scores at predicting mortality after Mitraclip in this meta-analysis. Methods MEDLINE, Embase and Cochrane databases from 1 January 1980 to 31 December 2018 were searched. Two authors reviewed studies which reported c-statistics of risk models to predict mortality after Mitraclip for inclusion, followed by data extraction and pooled analyses. Results Amongst 494 articles searched, 47 full-text articles were evaluated, and 4 studies totalling 879 Mitraclip cases were included for analyses. Operative mortality was reported at 3.3–7.4% in three studies, and 1-year mortality 11.2%-13.5% in two studies. C-statistics (95% confidence interval) for operative mortality were EuroSCORE 0.66 (0.57–0.75), EuroSCORE II 0.72 (0.60–0.85) and STS Score 0.64 (0.56–0.73). Respective Peto's odds ratios (95% confidence interval) to assess calibration were EuroSCORE 0.21 (0.14–0.31), EuroSCORE II 0.43 (0.24–0.76) and STS Score 0.36 (0.21–0.61). C-statistics (95% confidence interval) for 1-year mortality were EuroSCORE II 0.64 (0.57–0.70) and STS Score (0.58–0.64). Conclusion All scores over-estimated operative mortality, and EuroSCORE II had the best moderate discrimination while the other two scores were only modestly prognostic. Development of Mitraclip-specific scores may improve accuracy of risk stratification for this procedure to guide clinical decision-making.

scholarly journals Antiplatelet Therapy After Spontaneous Intracerebral Hemorrhage and Functional Outcomes

Stroke ◽  
2019 ◽  
Vol 50 (11) ◽  
pp. 3057-3063
Author(s):  
Santosh B. Murthy ◽  
Alessandro Biffi ◽  
Guido J. Falcone ◽  
Lauren H. Sansing ◽  
Victor Torres Lopez ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Antiplatelet Therapy ◽  
Functional Outcomes ◽  
Randomized Clinical Trials ◽  
Massachusetts General Hospital ◽  
Meta Analysis ◽  
Hazard Ratio ◽  
Stroke Registry ◽  
All Cause Mortality

Background and Purpose— Observational data suggest that antiplatelet therapy after intracerebral hemorrhage (ICH) alleviates thromboembolic risk without increasing the risk of recurrent ICH. Given the paucity of data on the relationship between antiplatelet therapy after ICH and functional outcomes, we aimed to study this association in a multicenter cohort. Methods— We meta-analyzed data from (1) the Massachusetts General Hospital ICH registry (n=1854), (2) the Virtual International Stroke Trials Archive database (n=762), and (3) the Yale stroke registry (n=185). Our exposure was antiplatelet therapy after ICH, which was modeled as a time-varying covariate. Our primary outcomes were all-cause mortality and a composite of major disability or death (modified Rankin Scale score 4–6). We used Cox proportional regression analyses to estimate the hazard ratio of death or poor functional outcome as a function of antiplatelet therapy and random-effects meta-analysis to pool the estimated HRs across studies. Additional analyses stratified by hematoma location (lobar and deep ICH) were performed. Results— We included a total of 2801 ICH patients, of whom 288 (10.3%) were started on antiplatelet medications after ICH. Median times to antiplatelet therapy ranged from 7 to 39 days. Antiplatelet therapy after ICH was not associated with mortality (hazard ratio, 0.85; 95% CI, 0.66–1.09), or death or major disability (hazard ratio, 0.83; 95% CI, 0.59–1.16) compared with patients not started on antiplatelet therapy. Similar results were obtained in additional analyses stratified by hematoma location. Conclusions— Antiplatelet therapy after ICH appeared safe and was not associated with all-cause mortality or functional outcome, regardless of hematoma location. Randomized clinical trials are needed to determine the effects and harms of antiplatelet therapy after ICH.

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