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Psychological outcomes in paediatric major trauma patients who require invasive management: protocol for a systematic
Owen Hibberd1,2, Caroline E Thomas3, Sarah Gentle2
1Emergency and Urgent Care Research in Cambridge (EURECA), PACE Section, Department of Medicine, Cambridge University, Cambridge, UK oh296@cam.ac.uk.
Insights
This study investigates if pediatric trauma patients needing surgery or interventional radiology (IR) face higher risks of psychological issues than those treated non-invasively. Findings will inform trauma care for children.
Area of Science:
- Pediatric trauma care
- Psychological outcomes in pediatric patients
- Interventional radiology
Background:
- Major trauma in children often necessitates invasive procedures like operations or interventional radiology (IR).
- Adverse psychological outcomes are common in pediatric trauma patients, with invasive management potentially increasing this risk.
- The comparative risk of psychological outcomes between invasive and conservative management in pediatric major trauma is not well-established.
Purpose of the Study:
- To determine if pediatric major trauma patients requiring an operation or IR have increased odds of adverse psychological outcomes compared to those managed conservatively.
- To systematically review and synthesize existing evidence on this topic.
Main Methods:
- Systematic review and meta-analysis following PRISMA guidelines.
- Comprehensive database searches (Medline, Embase, PsycInfo, Cinahl) up to February 2025.
- Quality assessment using Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale, with bias assessment via funnel plots and trim-fill analysis.
- Certainty of evidence evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Main Results:
- This section is to be populated upon study completion as results are not yet available in the abstract.
- The study aims to quantify the association between invasive management (operation/IR) and adverse psychological outcomes in pediatric major trauma.
- Anticipated results will compare odds ratios and confidence intervals for psychological outcomes between invasive and conservative management groups.
Conclusions:
- This systematic review will provide crucial insights into the psychological risks associated with invasive procedures in pediatric major trauma.
- Findings will inform clinical decision-making regarding the balance between necessary interventions and potential psychological sequelae in pediatric trauma patients.
- The study will highlight areas for future research and potential interventions to mitigate psychological harm.
Introduction:
Paediatric major trauma patients with more severe injuries and physiological or biochemical abnormalities as a result of the injury are more likely to require invasive management in the form of an operation/interventional radiology (IR). Adverse psychological outcomes, such as post-traumatic stress disorder, anxiety, depression and adjustment disorder, are frequently observed in paediatric patients with major trauma. Similarly, it is recognised that children and adolescents who have invasive management are also at an increased risk of adverse psychological outcomes. However, it is not known to what extent major trauma patients requiring invasive management are at risk of adverse psychological outcomes compared with those managed conservatively. This study aims to determine whether paediatric major trauma patients who require an operation/IR have increased odds of having an adverse psychological outcome compared with those who are managed conservatively.
Methods And Analysis:
The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines will be used to construct this review. The databases Medline (via Ovid), Embase (via Ovid), PsycInfo (via Ebscohost) and Cinahl (via Ebscohost) will be searched from inception to February 2025. Both title and abstract screening and full-text screening will be done by two reviewers, with an adjudicating third reviewer. For randomised controlled trials, the Cochrane Risk of Bias Tool will be employed, while for non-randomised studies, the Newcastle-Ottawa Quality Assessment Scale will be used. We will assess bias using contoured funnel plots (with p set at 0.01, 0.05 and 0.10), non-parametric trim-fill analysis, leave-one-out analysis and Galbraith plotting. We will execute formal (Egger) testing for funnel plot asymmetry and also calculate prediction intervals if sufficient study N of 10 is accrued. Certainty and confidence in cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Ethics And Dissemination:
Ethical review is not required as no original data will be collected. Results will be disseminated through peer-reviewed publications and at academic conferences.
Prospero Registration Number:
CRD42025643459.
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