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; Jan Y Verbakel

doi:10.3399/BJGP.2024.0141

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

Br J Gen Pract. 2024 Aug 8:BJGP.2024.0141. doi: 10.3399/BJGP.2024.0141. Online ahead of print.

Authors

Ruben Burvenich^{1

2

3

4}, David Ag Bos^{5

2}, Lien Lowie⁶, Kiyano Peeters⁶, Jaan Toelen^{7

8}, Laure Wynants^{5

7

9}, Jan Y Verbakel^{5

2

10}

Affiliations

¹ LUHTAR, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium ruben.burvenich@kuleuven.be.
² KU Leuven Academic Center for General Practice, Department of Public Health and Primary Care, Leuven, Belgium.
³ Department of Family Medicine and Primary Healthcare, Ghent University, 10 Corneel Heymanslaan, Ghent, 9000, Belgium.
⁴ Menzies Research Institute, University of Tasmania, Hobart, Tasmania, 7000, Australia.
⁵ LUHTAR, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
⁶ KU Leuven, Faculty of Medicine, Leuven, Belgium.
⁷ KU Leuven, Woman and Child, Department of Development and Regeneration, Leuven, Belgium.
⁸ University Hospitals Leuven, Department of Pediatrics, Leuven, Belgium.
⁹ Maastricht University Care and Public Health Research Institute, Department of Epidemiology, Maastricht, Netherlands.
¹⁰ Oxford University, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom.

Abstract

Background: Safety netting advice (SNA) can help in the management of acutely ill children.

Aim: Assess the effectiveness of different SNA methods for acutely ill children on antibiotic prescription and consumption.

Design and setting: Systematic review and network meta-analysis of randomised controlled trials, non-randomised trials of interventions, and controlled before-after studies in ambulatory care.

Method: We 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.

Results: We 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).

Conclusion: Paper 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.

Grants and funding

This study is part of Ruben Burvenich’s PhD project, which is funded by a KCE (Belgian Health Care Knowledge Centre) investigator-led trials programme (reference: KCE-181137 ARON), for which KU Leuven acts as the sponsor and Ghent University is a cooperating academic centre. The financing is mediated entirely by KU Leuven. No funding was provided for this study specifically.