scholarly journals Search methods for prognostic factor systematic reviews: a methodologic investigation

2021 ◽  
Vol 109 (1) ◽  
Author(s):  
Leah Boulos ◽  
Rachel Ogilvie ◽  
Jill A. Hayden
Keyword(s):  
Systematic Review ◽  
Prognostic Factor ◽  
Systematic Reviews ◽  
Search Strategy ◽  
Meta Analysis ◽  
Review Literature ◽  
Cochrane Library ◽  
Search Methods ◽  
Electronic Search ◽  
Study Results

Objective: This study retroactively investigated the search methods used in the 2019 Hayden et al. study, one of the first systematic reviews of prognostic factors that was published in the Cochrane Library. The review was designed to address recognized weaknesses in reviews of prognosis by using multiple supplementary search methods in addition to traditional electronic database searching.Methods: The authors used four approaches to comprehensively assess aspects of systematic review literature searching for prognostic factor studies: (1) comparison of search recall of broad versus focused electronic search strategies, (2) linking of search methods of origin for eligible studies, (3) analysis of impact of supplementary search methods on meta-analysis conclusions, and (4) analysis of prognosis filter performance.Results: The review’s focused electronic search strategy resulted in a 91% reduction in recall, compared to a broader version. Had the team relied on the focused search strategy without using supplementary search methods, they would have missed 23 of 58 eligible studies that were indexed in MEDLINE; additionally, the number of included studies in 2 of the review’s primary outcome meta-analyses would have changed. Using a broader strategy without supplementary searches would still have missed 5 studies. The prognosis filter used in the review demonstrated the highest sensitivity of any of the filters tested.Conclusions: Our study results support recommendations for supplementary search methods made by prominent systematic review methodologists. Leaving out any supplemental search methods would have resulted in missed studies, and these omissions would not have been prevented by using a broader search strategy or any of the other prognosis filters tested.

scholarly journals Oral Microbiome Response to Powered vs Manual Toothbrush: Protocol for a Systematic Review & Meta-Analysis

2020 ◽  
Author(s):  
Abanoub Riad ◽  
Jitka Klugarova ◽  
Veronika Chuchmova ◽  
Simona Slezakova ◽  
Andrea Pokorna ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Oral Microbiome ◽  
Primary Data ◽  
Cochrane Library ◽  
Process Data ◽  
Post Intervention ◽  
Screening Process ◽  
Study Results

Abstract Background: Subclinical changes in response to different types of toothbrushes represent a challenging knowledge gap in the context of self-administered oral hygiene regimes; therefore, this systematic review will be the first to evaluate the oral microbiome response to powered versus manual toothbrushes.Methods: We will conduct a systematic review using the Cochrane Handbook’s guidelines and will adhere to a standardized reporting format: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search strategy will be conducted in the following databases for published studies: Ovid MEDLINE(R), EMBASE, Cochrane Library, Web of Science, Scopus, ProQuest Central, ProQuest Dissertations Theses Global, Bibliographia Medica Cechoslovaca, and Dentistry Oral Sciences Source. Following a two-level screening process, data including the full reference, objectives, target population, description of the intervention and control intervention, outcome measures, design, length of the post-intervention follow-up period, and the study results will be extracted, synthesized, and reported. Risk of bias and quality of the studies will also be assessed.Discussion: No primary data collection will be undertaken; therefore, no formal ethical assessment is required. The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.Registration: The protocol has been registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42020153557) since April 28th, 2020.

scholarly journals Generic Patient-Reported Outcomes and Outcome Measures: A Systematic Review Study Protocol

2021 ◽  
Author(s):  
Yuki Seidler ◽  
Erika Mosor ◽  
Margaret R Andrews ◽  
Carolina Watson ◽  
Nick Bott ◽  
...  
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Systematic Reviews ◽  
Patient Reported Outcomes ◽  
Outcome Measurement ◽  
Meta Analysis ◽  
Patient Reported Outcome ◽  
Cochrane Library ◽  
Screening Process ◽  
Patient Reported

Background: Patient-reported outcomes (PROs) are an essential part of health outcome measurement and vital to patient-centricity and valued-based care. Several international consortia have developed core outcome sets and many of them include PROs. PROs are measured by patient-reported outcome measures (PROMs). PROs and PROMs can be generic or specific to certain diseases or conditions. While the characteristics of generic PROs and PROMs are well recognised as widely relevant and applicable across different domains, diseases and conditions, there is a lack of knowledge on the types of PROs measured by generic PROMs. We also do not know in which disease areas generic PROs and PROMs are commonly used. To date, there has been no systematic review solely focusing on generic PROMs, what they measure and their areas of application. Objectives: This systematic review will identify core PROs measured by generic PROMs used in adult populations and the areas in which they are applied. Methods: We will conduct a systematic review of reviews. The screening process and the reporting will comply with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 Statement. We will use four databases, Medline [PubMed], CINHAL [Ebsco], Cochrane [Cochrane Library], and PsycINFO [Ovid], and reports from international consortia. Inclusion criteria are systematic reviews, meta-analysis or patient-reported outcome sets developed by international consortia reporting on generic PROMs in adult populations. Articles primarily focusing on patient-reported experience measures (PREMs), children or adolescents, or those not written in English will be excluded. Risk of bias will be assessed by checking if the included articles comply with established guidelines for systematic reviews such as the PRISMA statement. We will extract generic PROMs and PROs measured by these PROMs, and the areas applied from the selected articles and reports. Extracted data and information will be quantitatively and qualitatively synthesised without statistical interference. The quality of the synthesised evidences will be assessed by clarifying the strengths, limitations and possible biases in our review.

Effectiveness of Physiotherapy to Promote Motor Recovery in Individuals with Stroke: A Systematic Review Protocol

2022 ◽  
Author(s):  
Shehong Zhang ◽  
Hongyu Xie ◽  
Chuanjie Wang ◽  
Fengfeng Wu ◽  
Xin Wang
Keyword(s):  
Systematic Review ◽  
Motor Function ◽  
Systematic Reviews ◽  
Evaluation System ◽  
Meta Analysis ◽  
Primary Data ◽  
Cochrane Library ◽  
Systematic Review Protocol ◽  
Qualitative Synthesis ◽  
Review Protocol

Abstract Introduction: Motor function is essential in our daily lives, one of the most common impairments caused by stroke is loss of functional movement. Over 70% of stroke survivors have motor or other neurological functional disabilities. However, rehabilitation of motor function suffered from a stroke can be rather difficult due to the complexity of organs and systems related to motor function, as well as the neural system that supported motor function. In particularly, previous evidence for the effectiveness of physiotherapy, a commonly prescribed intervention method for people with stroke, that recover motor function in people following a stroke is varied and limited in the chronic rehabilitation phase and therefore has never been reviewed systematically. With the progress of study in neurology and the development of novel tools for rehabilitation, results from more and more clinical trials are now available, thus here justifying conducting a systematic review. Methods and analysis: This systematic review protocol is developed in accordance with the methodology recommended by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols, as well as the Cochrane handbook for systematic reviews of interventions. Relevant studies will be identified by searching the databases. We will perform searches for relevant studies in databases, including PubMed, Embase, CINAHL, and Web of Science, Physiotherapy Evidence Database and Cochrane Library databases. The reference lists of included articles and reviews will be searched manually. The date range parameters used in searching all databases will be restricted between January 2001 and January 2021. Randomized controlled trials (RCTs) published will be included. The language used in the articles included was restricted to English. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation system from the Cochrane Handbook for Systematic Reviews of Interventions) approach will be used to systematically appraise the quality of methodology. We will assess the risk of bias of the RCTs included using the Cochrane Collaboration’s tool and provide a qualitative synthesis. After that, we will consider conducting a meta-analysis if the final data across outcomes shows sufficient homogeneity. Ethics and dissemination: No ethical approval is needed as the proposed study does not involve the collection of primary data, and the results of this review will be disseminated via peer-reviewed publications and conference presentations. Trial registration number: CRD42021267069.

scholarly journals Clinical Considerations for Return to Driving a Car following a Total Knee or Hip Arthroplasty: A Systematic Review

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Annalisa Na ◽  
Kacy Richburg ◽  
Zbigniew Gugala
Keyword(s):  
Systematic Reviews ◽  
Hip Arthroplasty ◽  
Response Times ◽  
Meta Analysis ◽  
Patient Characteristics ◽  
Postoperative Management ◽  
Cochrane Library ◽  
Clinical Factors ◽  
Study Results ◽  
Meta Analyses

Aim. The purpose of this study is to systematically review patient characteristics and clinical determinants that may influence return to driving status and time frames following a primary TKA or THA and provide an update of the current literature. Methods. This review was completed per the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Final electronic database searches were completed in October 2019 in Medline/PubMed, Medline/OVID, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Library using preselected search terms. Manuscripts of prospective and nonrandomized studies that examined the return to driving a car after a primary knee or hip arthroplasty patients were included. The Methodological Index for Non-Randomized Studies was used to measure study quality. Two authors selected studies and assessed their qualities. All disagreements were resolved through discussion and, as needed, a third reviewer. Data on study title, author(s), country, year, study design, sample size, inclusion and exclusion criteria, age, BMI, gender, statistical analyses, driving measure, follow-up time, surgical approach, laterality, and postoperative management were extracted from each study. Results. A total of 23 studies were eligible, including 12 TKA studies (n=654) with mean ages between 43 and 82 years, 9 THA studies (n=922) with mean ages between 34 and 85 years, and 2 combined TKA and THA (TKA, n=815; THA, n=685), yielded MINORS scores between 6 and 12. Most patients achieved or exceeded preoperative response times between 1 and 8 weeks following a TKA and 2 days to 8 weeks following a THA, and/or self-reported return to driving between 1 week and 6 months. Influences on return to driving time included laterality and pain, but gender was mixed. Discussion/Conclusions. Study results were consistent with previous systematic reviews in that return to driving a car after a primary TKA or THA is highly variable, and most commonly occurs around 4 weeks, but can range between 2 and 8 weeks. While various patient and clinical factors can influence return to driving for a TKA or THA, the most common contributing facts were pain and laterality. The heterogeneous nature of the studies prevented a meta-analysis for determining contributions of return to driving following a primary TKA or THA. Regardless, this study updates previous systematic reviews and presents insight on patient and clinical factors beyond generalized timeframes for return to driving a car. This information and results from future studies are essential to guide clinical recommendations and patient and clinician expectations for return to driving a car after a primary TKA or THA.

Simultaneous compared to interval administration of mifepristone and misoprostol for medical abortion up to 10+0 weeks' gestation: a systematic review with meta-analyses

2020 ◽  
pp. bmjsrh-2019-200448
Author(s):  
Mia Schmidt-Hansen ◽  
Jonathan Lord ◽  
Elise Hasler ◽  
Sharon Cameron
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Medical Abortion ◽  
Cochrane Library ◽  
Published Data ◽  
Study Results ◽  
Randomised Controlled ◽  
Meta Analyses

BackgroundMedical abortion with mifepristone and misoprostol usually involves an interval of 36–48 hours between administering these drugs; however, it is possible that the clinical efficacy at early gestations may be maintained when the drugs are taken simultaneously. The objective of this systematic review was to determine the safety and effectiveness of simultaneous compared with interval administration of mifepristone and misoprostol for abortion up to 10+0 weeks’ gestation.MethodsWe searched Embase Classic, Embase; Ovid MEDLINE(R) including Daily, and Epub Ahead-of-Print, In-Process & Other Non-Indexed Citations; and Cochrane Library on 11 December 2019. We included randomised controlled trials (RCTs), published in English from 1985, comparing simultaneous to interval administration of mifepristone and misoprostol for early abortion. Risk of bias was assessed using the Cochrane Collaboration checklist for RCTs. Meta-analysis of risk ratios (RRs) using the Mantel-Haenszel method were performed. The quality of the evidence was assessed using GRADE.ResultsMeta-analyses of three RCTs (n=1280) showed no differences in ‘ongoing pregnancy’ (RR 1.78, 95% CI 0.38 to 8.36), ‘haemorrhage requiring transfusion or ≥500 mL blood loss’ (RR 0.11, 95% CI 0.01 to 2.03) and ‘incomplete abortion with the need for surgical intervention’ (RR 1.30, 95% CI 0.76 to 2.25) between the interventions. Individual study results showed no difference in patient satisfaction, or ‘need for repeat misoprostol’, although ‘time to onset of bleeding or cramping’ was longer after simultaneous than interval administration. The quality of evidence was very low to moderate.ConclusionThe published data support the use of simultaneous mifepristone and misoprostol for medical abortion up to 9+0 weeks in women who prefer this method of administration.

scholarly journals Clinical, laboratory and imaging predictors for critical illness and mortality in patients with COVID-19: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e039813
Author(s):  
Xinxing Lai ◽  
Jian Liu ◽  
Tianyi Zhang ◽  
Luda Feng ◽  
Ping Jiang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Prognostic Factors ◽  
Critical Illness ◽  
Systematic Reviews ◽  
Clinical Laboratory ◽  
Data Extraction ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Early Management ◽  
Modifiable Factors

IntroductionWith the threat of a worldwide pandemic of COVID-19, it is important to identify the prognostic factors for critical conditions among patients with non-critical COVID-19. Prognostic factors and models may assist front-line clinicians in rapid identification of high-risk patients, early management of modifiable factors, appropriate triaging and optimising the use of limited healthcare resources. We aim to systematically assess the clinical, laboratory and imaging predictors as well as prediction models for severe or critical illness and mortality in patients with COVID-19.Methods and analysisAll peer-reviewed and preprint primary articles with a longitudinal design that focused on prognostic factors or models for critical illness and mortality related to COVID-19 will be eligible for inclusion. A systematic search of 11 databases including PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, VIP, Wanfang Data, SinoMed, bioRxiv, Arxiv and MedRxiv will be conducted. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data extraction will be performed using the modified version of the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist and quality will be evaluated using the Newcastle-Ottawa Scale and the Quality In Prognosis Studies tool. The association between prognostic factors and outcomes of interest will be synthesised and a meta-analysis will be conducted with three or more studies reporting a particular factor in a consistent manner.Ethics and disseminationEthical approval was not required for this systematic review. We will disseminate our findings through publication in a peer-reviewed journal.PROSPERO registration numberCRD 42020178798.

scholarly journals Risk factors for new ischaemic cerebral lesions after carotid artery stenting: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030025 ◽  
Author(s):  
Yao Feng ◽  
Long Li ◽  
Xuesong Bai ◽  
Tao Wang ◽  
Yanfei Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Carotid Artery ◽  
Systematic Reviews ◽  
Carotid Artery Stenting ◽  
Meta Analysis ◽  
Primary Data ◽  
Occurrence Rate ◽  
Cochrane Library ◽  
Cerebral Lesions

IntroductionNew ischaemic cerebral lesions (NICL) detected by diffusion-weighted imaging MRI are common after carotid artery stenting (CAS), with an occurrence rate ranging from 18% to 57%. Many studies reported occurrence of NICL could increase risk of future cerebrovascular events and cognitive impairment. However, controversies about determinants for occurrence of NICL after CAS exist among studies, and one risk factor embodied in an article may not be in another. Aim of this study is to introduce a protocol for a systematic review and meta-analysis to identify risk factors associated with occurrence of NICL after CAS.Methods and analysisAll relevant literature referring to risk factors for occurrence of NICL after CAS will be searched on the major databases, such as PubMed, Embase, Web of Science and the Cochrane Library until 31 December 2018. Literature, which must be randomised controlled trials, case–control studies or cohort studies, will be included in accordance with the prespecified eligibility criteria. The risk of bias will be assessed using the Cochrane Collaboration criteria and the quality of evidence will be assessed with the corresponding scale. Data will be extracted with a form prepared before and analysed using RevMan V.5.3 analyses software. Heterogeneity will be assessed using I2statistic. Our systematic review will be performed according to the guidance from the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Ethics and disseminationThere is no need for ethical approval because primary data will not be attained. The systematic review will be presented at international conferences and published in peer-reviewed journals.PROSPERO registration numberCRD42019121129

scholarly journals Effectiveness of Telemonitoring for Reducing Exacerbation Occurrence in COPD Patients With Past Exacerbation History: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Jing-wen Lu ◽  
Yu Wang ◽  
Yue Sun ◽  
Qin Zhang ◽  
Li-ming Yan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Room ◽  
Acute Exacerbation ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Control Group ◽  
Chronic Obstructive ◽  
Emergency Room Visits ◽  
Hospital Days

Background: Although an increasing number of studies have reported that telemonitoring (TM) in patients with chronic obstructive pulmonary disease (COPD) can be useful and efficacious for hospitalizations and quality of life, its actual utility in detecting and managing acute exacerbation of COPD (AECOPD) is less established. This meta-analysis aimed to identify the best available evidence on the effectiveness of TM targeting the early and optimized management of AECOPD in patients with a history of past AECOPD compared with a control group without TM intervention.Methods: We systematically searched PubMed, Embase, and the Cochrane Library for randomized controlled trials published from 1990 to May 2020. Primary endpoints included emergency room visits and exacerbation-related readmissions. P-values, risk ratios, odds ratios, and mean differences with 95% confidence intervals were calculated.Results: Of 505 identified citations, 17 original articles with both TM intervention and a control group were selected for the final analysis (N = 3,001 participants). TM was found to reduce emergency room visits [mean difference (MD) −0.70, 95% confidence interval (CI) −1.36 to −0.03], exacerbation-related readmissions (risk ratio 0.74, 95% CI 0.60–0.92), exacerbation-related hospital days (MD −0.60, 95% CI −1.06 to −0.13), mortality (odds ratio 0.71, 95% CI 0.54–0.93), and the St. George's Respiratory Questionnaire (SGRQ) score (MD −3.72, 95% CI −7.18 to −0.26) but did not make a difference with respect to all-cause readmissions, the rate of exacerbation-related readmissions, all-cause hospital days, time to first hospital readmission, anxiety and depression, and exercise capacity. Furthermore, the subgroup analysis by observation period showed that longer TM (≥12 months) was more effective in reducing readmissions.Conclusions: TM can reduce emergency room visits and exacerbation-related readmissions, as well as acute exacerbation (AE)-related hospital days, mortality, and the SGRQ score. The implementation of TM intervention is thus a potential protective therapeutic strategy that could facilitate the long-term management of AECOPD.Systematic Review Registration: This systematic review and meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement and was registered at International Prospective Register of Systematic Reviews (number: CRD42020181459).

scholarly journals Reporting quality of systematic review abstracts in articles hand and wrist pathology: a review

2019 ◽  
Vol 2 (2) ◽  
pp. 50-57
Author(s):  
Amanda Yang Shen ◽  
Robert S Ware ◽  
Tom J O'Donohoe ◽  
Jason Wasiak
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
English Language ◽  
Meta Analysis ◽  
Reporting Quality ◽  
Cochrane Library ◽  
Annual Basis ◽  
Cochrane Reviews ◽  
Abstract Reporting

Background: An increasing number of systematic reviews are published on an annual basis. Although perusal of the full text of articles is preferable, abstracts are sometimes relied upon to guide clinical decisions. Despite this, the abstracts of systematic reviews have historically been poorly reported. We evaluated the reporting quality of systematic review abstracts within hand and wrist pathology literature. Methods: We searched MEDLINE®, EMBASE and Cochrane Library from inception to December 2017 for systematic reviews in hand and wrist pathology using the 12-item PRISMA-A checklist to assess abstract reporting quality. Results: A total of 114 abstracts were included. Most related to fracture (38%) or arthritis (17%) management. Forty-seven systematic reviews (41%) included meta-analysis. Mean PRISMA-A score was 3.6/12 with Cochrane reviews having the highest mean score and hand-specific journals having the lowest. Abstracts longer than 300 words (mean difference [MD]: 1.43, 95% CI [0.74, 2.13]; p <0.001) and systematic reviews with meta-analysis (MD: 0.64, 95% CI [0.05, 1.22]; p = 0.034) were associated with higher scores. Unstructured abstracts were associated with lower scores (MD: –0.65, 95% CI [–1.28, –0.02]; p = 0.044). A limitation of this study is the possible exclusion of relevant studies that were not published in the English language. Conclusion: Abstracts of systematic reviews pertaining to hand and wrist pathology have been suboptimally reported as assessed by the PRISMA-A checklist. Improvements in reporting quality could be achieved by endorsement of PRISMA-A guidelines by authors and journals, and reducing constraints on abstract length.

scholarly journals Predictors of Post-Thrombotic Syndrome (PTS) in Pediatric Thrombosis: A Systematic Review and Meta-Analysis of the Literature

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3806-3806 ◽  
Author(s):  
Elissa Engel ◽  
Manuela Albisetti ◽  
Leonardo R. Brandao ◽  
Ernest Amankwah ◽  
Anthony Nguyen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Prognostic Factors ◽  
Prognostic Factor ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Factors Associated ◽  
Post Thrombotic Syndrome ◽  
Statistical Heterogeneity

Abstract BACKGROUND: Post-thrombotic syndrome (PTS) is the most common long-term complication in pediatric deep venous thrombosis (DVT), affecting approximately 25% of children with an extremity DVT. PTS leads to a high physical, psychological and financial burden in affected patients. Although several risk factors have been associated with the development of pediatric PTS, few of them have been validated in the pediatric literature. A better understanding of the prognostic factors leading to PTS is a vital step for early identification of those children at greatest risk in order to develop risk-stratified interventions aimed at preventing this complication. AIM: To perform a systematic review and meta-analysis of available published evidence from the pediatric literature on prognostic factors for pediatric PTS. METHODS: A systematic search of MEDLINE, EMBASE, and the Cochrane Library from 1960 to December 2017 was performed. MeSH terms and search strategy employed were as follows: "postthrombotic syndrome" OR "postphlebitic syndrome" AND "all child 0-18 years" AND "young adult 19-24 years". A study was eligible for inclusion if it evaluated the development of PTS in pediatric patients (<21 years of age) with a confirmed extremity DVT and reported on at least one prognostic factor for the development of PTS. Single case reports, narrative reviews, and commentaries were excluded. Studies assessing the efficacy/safety of thrombolysis, and studies including patients >21 years of age with outcomes not reported by age group, were also excluded. Two reviewers independently screened all studies and extracted the data of interest. Data were analyzed using STATA v.15 statistical software. Meta-analyses were conducted for risk factors reported in at least three studies. Summary odds ratios (ORs) and 95% confidence intervals (CI) were calculated from the effect estimates from the individual studies using a random effects model. Statistical heterogeneity was quantified by I2 statistic. RESULTS: A total of 12 studies met the final inclusion criteria (Figure 1), nine cohort studies, two cross-sectional studies, and one case-control study. These studies reported a total of 1,160 patients with venous thromboembolism (VTE), of whom 938 (81%) were assessed for PTS (Table 1). Median age across studies ranged from 0.02 - 15.5 years. VTE was considered provoked in nearly 80% of patients. The most common reported risk factor for VTE was the presence of a central venous catheter (CVC, 54%) followed by congenital heart disease (26%). PTS was diagnosed in 46% (n=434) of patients with an extremity DVT. The median time from DVT diagnosis to PTS diagnosis ranged from 12 to 33 months across studies. Among studies reporting this information, mild PTS was most frequently diagnosed, followed by moderate and severe PTS (35%, 5% and 0.6% of patients respectively). Most common prognostic factors associated with PTS in individual studies included patient characteristics: age and gender; and DVT characteristics: recurrent DVT, symptomatic DVT, DVT degree of occlusion, and time between DVT diagnosis and PTS assessment. Three studies investigated the association of elevated factor VIII and d-dimer levels with PTS. Elevated levels of these biomarkers were found to be associated with development of adverse VTE outcomes in one study but this finding was not confirmed in the other studies. Meta-analysis of reported prognostic factors identified the presence of a CVC and occlusive DVT as significant risk factors for the development of pediatric PTS (OR= 1.8, 95%CI=1.08-2.98, and OR=1.89, 95%CI=1.04-3.46 respectively; Figure 2). CONCLUSION: Among 12 studies evaluating prognostic factors for PTS in children and meeting criteria for this meta-analysis, CVC-related DVT and complete occlusion were associated with pediatric PTS. Overall, high-quality evidence on pediatric PTS is lacking. Collaborative prospective cohort studies and trials that use validated pediatric PTS measures and standardized prognostic factor definitions are needed to better understand the risk factors associated with PTS. Disclosures No relevant conflicts of interest to declare.

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