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

Background Cochrane Tool for Cluster-Randomised Safety-netting advice (SNA) can help in ^Trials, and the Risk Of Bias In the management of acutely ill children. ^{Non-randomised Studies — of} Interventions tool. Certainty of Aim evidence was assessed using the To assess the effectiveness of different Confidence in Network Meta-Analysis SNA methods on antibiotic prescription approach. Sensitivity analyses and and consumption in acutely ill children. network meta-regression were performed. Design and setting Systematic review and network Results meta-analysis of randomised In total, 30 studies (20 interventions) controlled trials, cluster randomised ^{were included. Compared with} usual trials, non-randomised studies care, paper SNA may reduce: antibiotic of interventions, and controlled prescribing (odds ratio [OR] 0.66, before–after studies in ambulatory 95% confidence interval [CI] = 0.53 care in high-income countries. to 0.82, I ² = 92%, very low certainty, three studies, 35 988 participants), Method especially when combined with oral MEDLINE, Embase, Web of Science SNA (OR 0.40, 95% CI = 0.08 to Core Collection, and Cochrane 2.00, P-score = 0.86); antibiotic Central Register of Controlled Trials consumption (OR 0.39, 95% were searched (22 January 2024). CI = 0.27 to 0.58, low RoB, one study, Risk of bias (RoB) was assessed with 509 participants); and return visits Cochrane’s RoB 2 tool, the Revised (OR 0.74, 95% CI = 0.63 to 0.87). Compared with usual care, video SNA, read-only websites, oral SNA, and web-based SNA (in descending order of effectiveness) may increase parental knowledge (ORs 2.33–4.52), while paper SNA may not (ORs 1.18–1.62). Similarly, compared with usual care, video SNA and web-based modules may improve parental satisfaction (ORs 1.94–4.08), while paper SNA may not (OR 1.85, 95% CI = 0.48 to 7.08). Conclusion Paper SNA (with oral SNA) may reduce antibiotic use and return visits. Video, oral, and online SNA may improve parental knowledge, whereas video SNA and web-based modules may increase parental satisfaction.