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BMC Medicine Apr 2004Despite treatment recommendations from various organizations, oral rehydration therapy (ORT) continues to be underused, particularly by physicians in high-income... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Despite treatment recommendations from various organizations, oral rehydration therapy (ORT) continues to be underused, particularly by physicians in high-income countries. We conducted a systematic review of randomised controlled trials (RCTs) to compare ORT and intravenous therapy (IVT) for the treatment of dehydration secondary to acute gastroenteritis in children.
METHODS
RCTs were identified through MEDLINE, EMBASE, CENTRAL, authors and references of included trials, pharmaceutical companies, and relevant organizations. Screening and inclusion were performed independently by two reviewers in order to identify randomised or quasi-randomised controlled trials comparing ORT and IVT in children with acute diarrhea and dehydration. Two reviewers independently assessed study quality using the Jadad scale and allocation concealment. Data were extracted by one reviewer and checked by a second. The primary outcome measure was failure of rehydration. We analyzed data using standard meta-analytic techniques.
RESULTS
The quality of the 14 included trials ranged from 0 to 3 (Jadad score); allocation concealment was unclear in all but one study. Using a random effects model, there was no significant difference in treatment failures (risk difference [RD] 3%; 95% confidence intervals [CI]: 0, 6). The Mantel-Haenzsel fixed effects model gave a significant difference between treatment groups (RD 4%; 95% CI: 2, 5) favoring IVT. Based on the four studies that reported deaths, there were six in the IVT groups and two in ORT. There were no significant differences in total fluid intake at six and 24 hours, weight gain, duration of diarrhea, or hypo/hypernatremia. Length of stay was significantly shorter for the ORT group (weighted mean difference [WMD] -1.2 days; 95% CI: -2.4,-0.02). Phlebitis occurred significantly more often with IVT (number needed to treat [NNT] 33; 95% CI: 25,100); paralytic ileus occurred more often with ORT (NNT 33; 95% CI: 20,100). These results may not be generalizable to children with persistent vomiting.
CONCLUSION
There were no clinically important differences between ORT and IVT in terms of efficacy and safety. For every 25 children (95% CI: 20, 50) treated with ORT, one would fail and require IVT. The results support existing practice guidelines recommending ORT as the first course of treatment in appropriate children with dehydration secondary to gastroenteritis.
Topics: Child; Dehydration; Diarrhea; Fluid Therapy; Gastroenteritis; Humans; Infusions, Intravenous; Publication Bias; Rehydration Solutions; Sensitivity and Specificity
PubMed: 15086953
DOI: 10.1186/1741-7015-2-11 -
BMJ (Clinical Research Ed.) Mar 1998To evaluate the effect of heparin on duration of catheter patency and on prevention of complications associated with use of peripheral venous and arterial catheters. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the effect of heparin on duration of catheter patency and on prevention of complications associated with use of peripheral venous and arterial catheters.
DESIGN
Critical appraisal and meta-analysis of 26 randomised controlled trials that evaluated infusion of heparin intermittently or continuously. Thirteen trials of peripheral venous catheters and two of peripheral arterial catheters met criteria for inclusion.
MAIN OUTCOME MEASURES
Data on the populations, interventions, outcomes, and methodological quality.
RESULTS
For peripheral venous catheters locked between use flushing with 10 U/ml of heparin instead of normal saline did not reduce the incidence of catheter clotting and phlebitis or improve catheter patency. When heparin was given as a continuous infusion at 1 U/ml the risk of phlebitis decreased (relative risk 0.55; 95% confidence interval 0.39 to 0.77), the duration of patency increased, and infusion failure was reduced (0.88; 0.72 to 1.07). Heparin significantly prolonged duration of patency of radial artery catheters and decreased the risk of clot formation (0.51; 0.42 to 0.61).
CONCLUSIONS
Use of intermittent heparin flushes at doses of 10 U/ml in peripheral venous catheters locked between use had no benefit over normal saline flush. Infusion of low dose heparin through a peripheral arterial catheter prolonged the duration of patency but further study is needed to establish its benefit for peripheral venous catheters.
Topics: Adolescent; Adult; Anticoagulants; Catheterization, Peripheral; Child; Child, Preschool; Equipment Failure; Heparin; Humans; Infant; Infant, Newborn; Infusions, Intra-Arterial; Infusions, Intravenous; Phlebitis; Randomized Controlled Trials as Topic; Risk Factors
PubMed: 9550955
DOI: 10.1136/bmj.316.7136.969 -
Journal of Nuclear Medicine : Official... Dec 1991We systematically reviewed the six articles from the English-language medical literature, since 1979, which compared 99mTc-RBC venography with contrast venography for... (Comparative Study)
Comparative Study Meta-Analysis
We systematically reviewed the six articles from the English-language medical literature, since 1979, which compared 99mTc-RBC venography with contrast venography for the diagnosis of deep venous thrombosis (DVT) of the lower extremity. The studies were generally small in size and poorly compliant with methodologic standards for diagnostic test research. There was considerable variation in both how the 99mTc-RBC venograms were performed and how they were interpreted. Sufficient clinical information on the patients was not provided. Although the overall sensitivities and specificities were high with a mean sensitivity of 0.89 and a mean specificity of 0.84, the small numbers of patients resulted in wide 95% confidence intervals. For distal disease, with only a total of 14 patients studied, the 95% confidence intervals were particularly broad. Although 99mTc-RBC venography is a promising technique, future studies with larger numbers of patients and closer adherence to methodologic standards are required.
Topics: Erythrocytes; Meta-Analysis as Topic; Phlebography; Radionuclide Imaging; Sensitivity and Specificity; Technetium; Thrombophlebitis
PubMed: 1836023
DOI: No ID Found