Comparison of early surgical intervention to delayed surgical intervention for treatment of thermal burns in adults: A systematic review and meta-analysis
Notice bibliographique
Résumé
Burns are one of the most prevalent forms of wound in children and adults, although timing of surgical excision for deep partial or full thickness burns remains controversial. To determine if early surgical intervention (excision and grafting within 7 days) improves outcomes when compared to delayed surgical intervention (excision and grafting after 7 days) in adults with thermal burns. We searched the following electronic databases: Cochrane Wound Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and CINAHL. We hand searched the references of included studies and major review articles. We contacted authors of included trials for information about any ongoing trials or unpublished studies. Selection criteria: We included randomized controlled trials, both published and unpublished, comparing early versus delayed surgical intervention for treatment of thermal burns of all degrees and percent total body surface areas (%TBSA) in adult patients. Data collection and analysis: Two authors independently, and in duplicate, screened the titles abstracts and then full texts of all citations for possible inclusion. Data from eligible studies were extracted independently and in duplicate using Microsoft Excel. We pooled outcome data according to the guidelines of the Cochrane Collaboration using Review Manager 5.3 software and random effects model. We assessed Risk of Bias (RoB) in individual studies using the Cochrane Collaboration’s tool and overall certainty of evidence for each outcome using the GRADE framework. A total of 9 RCTs were included in the systematic review; 6 in the quantitative meta-analysis. Early surgical intervention may result in a small albeit imprecise reduction in mortality (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.53 to 1.14, I2 = 46%, very low certainty) and a reduction in length of hospital stay (days) (mean difference (MD) 12.66 days fewer; 95% CI 9.80 days fewer to 15.53 days fewer, I2 = 88%, low certainty), but increased need for red blood cell (RBC) units (MD 27.11; 95% CI 20.17 to 34.06 units, I2 = 99%, low certainty) compared to delayed surgical intervention. Additionally, early excision and grafting may result in better functional and cosmetic outcomes; both based on low certainty evidence. However, no difference in scar quality and proportion of burns requiring re-operation was found (both low certainty). Early excision and grafting may reduce mortality and improve other patient important outcomes in adults with thermal burns, however most outcomes are based on low or very low certainty evidence. Higher quality, methodologically rigorous studies examining health-related quality of life are warranted in order to best inform this clinical question.
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Comment cette classification a été obtenuedéplier
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 | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,014 | 0,005 |
| Bibliométrie | 0,000 | 0,001 |
| 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 | 0,000 |
| 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 découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».