• Br J Gen Pract · Aug 2024

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

    • Ruben Burvenich, David Ag Bos, Lien Lowie, Kiyano Peeters, Jaan Toelen, Laure Wynants, and Jan Y Verbakel.
    • LUHTAR, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium ruben.burvenich@kuleuven.be.
    • Br J Gen Pract. 2024 Aug 8.

    BackgroundSafety netting advice (SNA) can help in the management of acutely ill children.AimAssess the effectiveness of different SNA methods for acutely ill children on antibiotic prescription and consumption.Design And SettingSystematic review and network meta-analysis of randomised controlled trials, non-randomised trials of interventions, and controlled before-after studies in ambulatory care.MethodWe 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.ResultsWe 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).ConclusionPaper 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.

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