Effectiveness of safety netting approaches for acutely ill children: a network meta-analysis.

Autor:	Burvenich R; LUHTAR, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium ruben.burvenich@kuleuven.be.; KU Leuven Academic Center for General Practice, Department of Public Health and Primary Care, Leuven, Belgium.; Department of Family Medicine and Primary Healthcare, Ghent University, 10 Corneel Heymanslaan, Ghent, 9000, Belgium.; Menzies Research Institute, University of Tasmania, Hobart, Tasmania, 7000, Australia., Bos DA; LUHTAR, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.; KU Leuven Academic Center for General Practice, Department of Public Health and Primary Care, Leuven, Belgium., Lowie L; KU Leuven, Faculty of Medicine, Leuven, Belgium., Peeters K; KU Leuven, Faculty of Medicine, Leuven, Belgium., Toelen J; KU Leuven, Woman and Child, Department of Development and Regeneration, Leuven, Belgium.; University Hospitals Leuven, Department of Pediatrics, Leuven, Belgium., Wynants L; LUHTAR, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.; KU Leuven, Woman and Child, Department of Development and Regeneration, Leuven, Belgium.; Maastricht University Care and Public Health Research Institute, Department of Epidemiology, Maastricht, Netherlands., Verbakel JY; LUHTAR, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.; KU Leuven Academic Center for General Practice, Department of Public Health and Primary Care, Leuven, Belgium.; Oxford University, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom.
Jazyk:	angličtina
Zdroj:	The British journal of general practice : the journal of the Royal College of General Practitioners [Br J Gen Pract] 2024 Aug 08. Date of Electronic Publication: 2024 Aug 08.
DOI:	10.3399/BJGP.2024.0141
Abstrakt:	Background: Safety netting advice (SNA) can help in the management of acutely ill children. Aim: Assess the effectiveness of different SNA methods for acutely ill children on antibiotic prescription and consumption. Design and Setting: Systematic review and network meta-analysis of randomised controlled trials, non-randomised trials of interventions, and controlled before-after studies in ambulatory care. Method: We searched MEDLINE, Embase, Web-Of-Science Core Collection, and Cochrane Central Register of Controlled Trials (22 January 2024). We assessed the risk of bias (RoB) with the Cochrane Tool 2, Revised Cochrane Tool for Cluster-Randomised Trials, and ROBINS-I tool. Certainty of evidence was assessed using the CINeMA approach. We performed sensitivity analyses and network meta-regression. Results: We included 30 studies (20 interventions). Compared to usual care, paper SNA may reduce antibiotic prescribing (OR=0.66 (95%CI: 0.53-0.85), I²=92%, very low certainty; 3 studies, 35,988 participants), especially when combined with oral SNA (OR=0.40 (95%CI: 0.08-2.00), P-score: 0.86), antibiotic consumption (OR=0.39 (95%CI: 0.27-0.58), low RoB; 1 study, 509 participants), and return visits (OR=0.74 , 95%CI 0.63-0.87). Paper SNA without antibiotics may reduce antibiotic consumption compared to paper SNA and delayed antibiotics (OR=0.27 (95%CI: 0.15-0.51, some RoB; 1 study, 206 participants). Video SNA, oral SNA, read-only websites, and web-based modules may increase parental knowledge (ORs 2.23-4.52). Video SNA and web-based modules may improve parental satisfaction (ORs 1.64-4.08). Conclusion: Paper SNA (with oral SNA) may reduce antibiotic use and return visits. Video, oral, and online SNA, may improve parental knowledge while video SNA and web-based modules may increase parental satisfaction. (Copyright © 2024, The Authors.)
Databáze:	MEDLINE
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