Surgical Versus Non-Surgical Treatment for Traumatic Esophageal Perforation in Children: A Systematic Review
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Notice bibliographique
Résumé
The study design of this paper is a systematic review of literature published in the recent 10 years. Esophageal perforations in children have long been a topic of debate. The management protocols are chiefly governed by symptom severity, perforation site, time elapsed since perforation and cause of perforation. Esophageal perforations in pediatric group of patients can be iatrogenic or traumatic. The aim to conduct the study was to assess the benefits and timely management of surgical versus non-surgical treatment for pediatric patients with traumatic esophageal perforation. The two research questions below were determined. We systematically reviewed retrospective serial studies assessing the medical treatment compared to the surgical interventions for the traumatic esophageal perforation in children. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Abstracts of Reviews of Effects, as well as foreign literature with English translations. No randomized controlled trial studies had been conducted in children with esophageal perforation. Information on patient s’ age, comorbidities, methods of treatment, and effects on mortality, morbidity were extracted. Three independent reviewers selected the articles for analysis after screening the titles, abstracts, and full texts, then extracted data and graded the quality of each paper according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Specific clinical questions were as follows. 1) In patients with early diagnosis of esophageal perforation, what are the indications for treatment (surgery versus conservative management) and its impact on prognosis? 2) In patients with delayed diagnosis, what are the indications for treatment (surgery versus conservative management) and its impact on mortality and morbidity rate? A total of 66 abstracts were identified using various keywords. Nine retrospective articles (level III) were eligible for inclusion, involving a total of 77 cases of esophageal perforation in pediatric patients. Non-operative management is recommended for perforations diagnosed within 24 - 48 hours in a stable patient with contained leakage, but hemodynamically unstable patients with a contained perforation, ongoing leakage and early diagnosed have a higher chance of successful primary repair, whereas delayed ones require conservative treatment. J Curr Surg. 2016;6(2):41-45 doi: http://dx.doi.org/10.14740/jcs296w
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,009 | 0,004 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle