Background
Methods and designs
Protocol registration
Focused review questions
Types of studies
Participants
Interventions and comparators
Outcome assessments
Search strategy
Citation management and screening
Data extraction
Assessment of risk of bias within studies
Statistical analysis
Trial sequential analysis
Assessment of heterogeneity
Assessment of publication biases
Rating certainty of evidence with the grading of recommendations assessment, development, and evaluation (GRADE) approach
Results
Study identification and selection
Author | Year | Fracture type | Primary outcome | Number of patients | Age (mean) | Number of males | Number of fractures | ISS (mean) | MV at randomization (%) | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
SM | NSM | Total | SM | NSM | SM | NSM | SM | NSM | SM | NSM | SM | NSM | ||||
Tanaka [20] | 2002 | Flail | MV days | 18 | 19 | 37 | 43 | 46 | 43 | 46 | 8.2 | 8.2 | 33 | 30 | 100 | 100 |
Granetzny [21] | 2005 | Flail | Pulmonary function | 20 | 20 | 40 | 40.5 | 36 | 17 | 14 | 4.4 | 4.6 | 16.8 | 18 | 35 | 45 |
Marasco [22] | 2012 | Flail | MV days/ ICU stay | 23 | 23 | 46 | 57.8 | 59.3 | 20 | 20 | 11 | 11.3 | 35 | 30 | 100 | 100 |
Wu [23] | 2015 | Flail | MV days/ ICU stay | 75 | 89 | 164 | 52 | 51 | 75 | 89 | 8.7 | 8.3 | 20.3 | 18.5 | 28 | 30.3 |
Liu [24] | 2019 | Flail | Mortality | 27 | 26 | 53 | 41.6 | 39.6 | 21 | 20 | 6.3 | 5 | 29 | 27.7 | NA | NA |
Pieracci [25] | 2020 | Simple | Pain | 51 | 59 | 110 | 54.6 | 55.3 | 39 | 43 | 7 | 7 | 13 | 14 | 0 | 0 |
Marasco [26] | 2022 | Flail | Pain | 61 | 63 | 124 | 59.1 | 55 | 48 | 51 | 6.7 | 6.7 | 14.7 | 16 | 0 | 0 |
Dehghan [10] | 2022 | Flail or severe chest wall deformity | Ventilator-free days | 108 | 99 | 207 | 52.9 | 53.2 | 81 | 75 | 10.1 | 10.5 | 25.3 | 26 | 41 | 46 |
Meyer [11] | 2023 | Flail segment without clinical flail chest | Length of hospital stay | 42 | 42 | 84 | 50 | 49 | 28 | 31 | 8.3 | 7.7 | 23.7 | 21.3 | NA | NA |
Assessment of bias
Outcomes
Mortality
Incidence of pneumonia
Need for tracheostomy
Duration of mechanical ventilation
ICU length of stay
Trial sequential analysis
Quality of evidence
Certainty assessment | No of patients | Effect | Certainty | Importance | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
No of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Surgery | Control | Relative (95% CI) | Absolute (95% CI) | ||
All-cause mortality | ||||||||||||
9 | Randomised trials | Seriousa | Not serious | Not serious | Seriousb | Publication bias strongly suspectedc | 7/423 (1.7%) | 18/439 (4.1%) | RR 0.53 (0.21 to 1.38) | 19 fewer per 1,000 (from 32 fewer to 16 more) | ⨁◯◯◯ Very low | |
Pneumonia | ||||||||||||
8 | Randomised trials | Seriousa | Not serious | Not serious | Not serious | None | 51/362 (14.1%) | 93/376 (24.7%) | RR 0.57 (0.35 to 0.92) | 106 fewer per 1,000 (from 161 to 20 fewer) | ⨁⨁⨁◯ Moderate | |
Tracheostomy | ||||||||||||
6 | Randomised trials | Seriousa | Not serious | Not serious | Seriousb,d | None | 42/291 (14.4%) | 63/297 (21.2%) | RR 0.70 (0.38 to 1.30) | 64 fewer per 1,000 (from 132 fewer to 64 more) | ⨁⨁◯◯ Low | |
Length of ICU stay | ||||||||||||
8 | Randomised trials | Seriousa | Seriouse | Not serious | Not serious | Publication bias strongly suspectedc | 372 | 380 | – | MD 3.05 days lower (5.87 lower to 0.22 lower) | ⨁◯◯◯ Very low | |
Length of hospital stay | ||||||||||||
7 | Randomised trials | Seriousa | Seriouse | Not serious | Seriousd | None | 354 | 361 | – | MD 3.79 days lower (9.33 lower to 1.75 higher) | ⨁◯◯◯ Very low | |
Duration of mechanical ventilation | ||||||||||||
7 | Randomised trials | Seriousa | Seriouse | Not serious | Not serious | None | 300 | 304 | – | MD 4.62 days lower (7.64 lower to 1.6 lower) | ⨁⨁◯◯ Low |