FROM THE AMERICAN ACADEMY OF PEDIATRICS Supplemental Information 1 PEDIATRICS Volume 142, number 6, December 2018 SUPPLEMENTAL FIGURE 2 Forest plot of all included RCTs using a random-effects model and M-H statistics with the outcome of hyponatremia (sodium <135 mEq/L). df, degrees of freedom. SUPPLEMENTAL FIGURE 3 Forest plot of all included RCTs with moderately hypotonic fluids (>70 mEq/L) compared with isotonic fluids. Random-effects model and M-H statistics with the outcome of hyponatremia (sodium <135 mEq/L) are shown. df, degrees of freedom.
Transcript
FROM THE AMERICAN ACADEMY OF PEDIATRICS
Supplemental Information
1PEDIATRICS Volume 142, number 6, December 2018
SUPPLEMENTAL FIGURE 2Forest plot of all included RCTs using a random-effects model and M-H statistics with the outcome of hyponatremia (sodium <135 mEq/L). df, degrees of freedom.
SUPPLEMENTAL FIGURE 3Forest plot of all included RCTs with moderately hypotonic fluids (>70 mEq/L) compared with isotonic fluids. Random-effects model and M-H statistics with the outcome of hyponatremia (sodium <135 mEq/L) are shown. df, degrees of freedom.
2
SUPPLEMENTAL FIGURE 4Forest plot of all included RCTs using a random-effects model and M-H statistics with the outcome of moderate hyponatremia (sodium <130 mEq/L). df, degrees of freedom.
FROM THE AMERICAN ACADEMY OF PEDIATRICS
3PEDIATRICS Volume 142, number 6, December 2018
SUPPLEMENTAL FIGURE 5Algorithm used to describe the selection of maintenance IVFs in children who are acutely ill.
4
SUPP
LEM
ENTA
L TA
BLE
3 Ev
iden
ce fo
r Fl
uid
Guid
elin
e, In
clud
ing
All C
linic
al Tr
ials
of M
aint
enan
ce IV
Fs fo
r Ch
ildre
n Ag
es 0
–18
Year
s Pu
blis
hed
Thro
ugh
Mar
ch 1
5, 2
016,
Usi
ng th
e Se
arch
Cri
teri
a De
scri
bed
in th
e Gu
idel
ine
Repo
rt
Auth
or (
Refe
renc
e)Ye
arAg
e Ra
nge
Popu
latio
nIn
terv
entio
nCo
ntro
lN
Find
ings
and
/or
Resu
lts
Alm
eida
et a
l3120
151
d–18
yIn
clud
ed: m
edic
al a
nd/o
r su
rgic
al P
ICU;
ex
clud
ed: s
ever
e el
ectr
olyt
e an
d ac
id-b
ase
dist
urba
nces
, met
abol
ic
dise
ase,
pla
sma
sodi
um <
135
or >
150,
an
d re
nal i
nsuf
ficie
ncy;
exc
lude
d fr
om
anal
ysis
if fl
uids
wer
e sw
itche
d or
in
terr
upte
d <2
4 h
D 5 0.9
% N
aCl,
for
resp
irat
ory,
50%
–90%
of
H-S
vol
ume,
for
abdo
min
al s
urge
ry,
100%
–120
% o
f H-S
vo
lum
e, fu
rose
mid
e fo
r ne
t 0 d
aily
wat
er b
alan
ce
D 5 0.4
5% N
aCl,
fluid
rat
es
sam
e as
inte
rven
tion
233
rand
omly
as
sign
edGr
oup
A (0
.9%
NaC
l) s
odiu
m
incr
ease
d by
2.9
1 m
Eq/L
. No
cha
nge
in p
H; G
roup
B
0.45
NaC
L 15
% p
atie
nts
with
so
dium
<13
5
Braz
el a
nd M
cPhe
e4819
9612
–18
yIn
clud
ed: f
emal
e pa
tient
s, p
osto
pera
tive
spin
al fu
sion
; exc
lude
d: n
ot e
xplic
itly
desc
ribe
d
Hart
man
n so
lutio
n at
1.5
m
L/kg
per
h (
n =
5)Ei
ther
D3 0
.3%
NaC
l (n
= 4)
or
D4 0
.18%
NaC
l (n
= 3)
12So
dium
<13
5 m
Eq/L
: iso
toni
c 1
in 5
, hyp
oton
ic: 7
in 7
; sod
ium
<1
30 m
Eq/L
: iso
toni
c 0
in 5
, hy
poto
nic
4 in
7Ch
oong
et a
l2020
116
mo–
16 y
Incl
uded
: pos
tope
rativ
e el
ectiv
e su
rger
y,
euvo
lem
ic w
ithin
6 h
; exc
lude
d:
unco
rrec
ted
sodi
um a
bnor
mal
ities
be
fore
end
of s
urge
ry, k
now
n AD
H ab
norm
aliti
es, r
equi
red
volu
me
resu
scita
tion
or v
asoa
ctiv
e in
fusi
on,
rece
nt lo
op d
iure
tics,
TPN
, cer
ebra
l ed
ema,
acu
te b
urns
, CHF
, ren
al fa
ilure
, liv
er fa
ilure
, and
cir
rhos
is
D 5 0.9
% N
aCl ±
KCl
D 5 0.4
5% N
aCl ±
KCl
258
Isot
onic
: 29
in 1
28 (
22.7
%)
had
hypo
natr
emia
; hyp
oton
ic:
53 in
130
(40
.8%
) ha
d hy
pona
trem
ia
Coul
thar
d et
al49
2012
52–1
69 m
oIn
clud
ed: p
osto
pera
tive
PICU
pat
ient
s af
ter
spin
al in
stru
men
tatio
n fo
r sc
olio
sis;
cra
niot
omy
for
tum
or o
r cr
ania
l rem
odel
ing;
exc
lude
d: le
ngth
y in
stru
men
tatio
n, v
entr
icul
oper
itone
al
shun
t pla
ced
or r
evis
ed, i
ntra
cere
bral
cy
st fe
nest
ratio
n, o
r pr
evio
usly
en
rolle
d
D 5 Har
tman
n so
lutio
n at
m
aint
enan
ceD 5 0
.5%
NaC
l at t
wo-
thir
ds
mai
nten
ance
82 (
79 a
naly
zed)
Sodi
um lo
wer
in h
ypot
onic
gr
oups
at 1
6–18
h
Flor
es R
oble
s an
d Cu
ello
Ga
rcía
5120
153
mo–
15 y
Incl
uded
: acu
te m
edic
al a
nd/o
r su
rgic
al
cond
ition
s re
quir
ing
adm
issi
on to
ge
nera
l ped
iatr
ic w
ard;
exc
lude
d:
sodi
um ≤
125
or ≥
155
on a
dmis
sion
; m
oder
ate-
to-s
ever
e de
hydr
atio
n; n
eed
for
volu
me
resu
scita
tion
or v
asoa
ctiv
e in
fusi
ons;
kid
ney,
car
diac
, end
ocri
ne,
or C
NS d
isor
ders
with
isot
onic
flui
d co
ntra
indi
cate
d; r
ecen
t diu
retic
use
; or
need
for
ICU
adm
issi
on
D 5 0.9
% N
aCl,
for
resp
irat
ory,
50%
–90%
of
H-S
vol
ume,
for
abdo
min
al s
urge
ry,
100%
–120
% o
f H-S
vo
lum
e, fu
rose
mid
e fo
r ne
t 0 d
aily
wat
er b
alan
ce
D 5 0.4
5% N
aCl a
nd D
3.3 0
.3%
Na
Cl16
3 ra
ndom
ly
assi
gned
Sodi
um lo
wer
in h
ypot
onic
gr
oups
at 8
h
FROM THE AMERICAN ACADEMY OF PEDIATRICS
5PEDIATRICS Volume 142, number 6, December 2018
Auth
or (
Refe
renc
e)Ye
arAg
e Ra
nge
Popu
latio
nIn
terv
entio
nCo
ntro
lN
Find
ings
and
/or
Resu
lts
Frie
dman
et a
l3220
151
mo–
18 y
Incl
uded
: pat
ient
s re
quir
ing
adm
issi
on
to g
ener
al p
edia
tric
war
d; e
xclu
sion
s:
card
iac,
ren
al o
r he
patic
failu
re;
hem
oglo
bulin
<6
g/dL
, por
tal
hype
rten
sion
with
asc
ites,
met
abol
ic
dise
ase,
DI,
DM, h
yper
tens
ion,
adr
enal
in
suffi
cien
cy, n
ephr
itic
or n
ephr
otic
sy
ndro
me,
and
Kaw
asak
i dis
ease
. Als
o ex
clud
ed if
pat
ient
was
ede
mat
ous,
re
quir
ed IC
U ca
re, o
r on
diu
retic
s or
ha
d gl
ucos
e >2
70 m
g/dL
D 5 0.9
% N
aCl
D 5 0.4
5% N
aCl
110
rand
omly
as
sign
edNo
cha
nge
in s
odiu
m a
t 48
h
Jorr
o Ba
rón
et a
l5020
131
mo–
18 y
(m
edia
n 3–
18
mo)
Incl
uded
: mix
ed m
edic
al a
nd/o
r su
rgic
al
with
exp
ecte
d PI
CU s
tay
>24
h w
ith
norm
al s
erum
sod
ium
; exc
lude
d:
prev
ious
kid
ney
failu
re, l
iver
failu
re
with
asc
ites
and
port
al h
yper
tens
ion,
ad
rena
l ins
uffic
ienc
y, n
ephr
otic
or
nep
hriti
c sy
ndro
me,
Kaw
asak
i di
seas
e, s
ickl
e ce
ll, D
I, co
ngen
ital
met
abol
ic d
isea
se, g
luco
se >
200,
TPN
, hy
perh
ydra
tion,
tum
or ly
sis
synd
rom
e,
on c
hem
othe
rapy
, rea
dmis
sion
to P
ICU
D 5 0.9
% N
aCl ±
KCl
, rat
e of
15
00 m
L/m
2 if >
10 k
g, 8
0 m
L/kg
if <
10 k
g
D 5 0.4
5% N
aCl ±
KCl
66 r
ando
mly
as
sign
ed (
63
anal
yzed
)
Isot
onic
sod
ium
(af
ter
infu
sion
): m
ean
140
± 4
.1 m
Eq/L
; hy
poto
nic
(aft
er in
fusi
on):
mea
n 13
7.8
± 4
.3 m
Eq/L
(P
= .0
4); i
soto
nic,
4 in
31
hypo
natr
emic
(<1
35 m
Eq/L
) an
d hy
poto
nic
5 in
32
hypo
Na
Kann
an e
t al52
2010
3 m
o–12
yIn
clud
ed: c
hild
ren
who
wer
e ho
spita
lized
ne
edin
g IV
flui
ds fo
r 24
h; e
xclu
ded:
in
itial
hyp
onat
rem
ia o
r hy
pern
atre
mia
, po
stop
erat
ive,
deh
ydra
tion,
sho
ck,
seve
re m
alnu
triti
on, c
irrh
osis
, CHF
, re
nal f
ailu
re, n
ephr
otic
syn
drom
e, o
r on
dru
gs a
ffect
ing
plas
ma
(sod
ium
)
Grou
p A:
D5 0
.9%
NaC
l at
stan
dard
mai
nten
ance
ra
te
Grou
p B:
D5 0
.18%
NaC
l at
stan
dard
mai
nten
ance
ra
te; G
roup
C: D
5 0.1
8%
NaCl
at t
wo-
thir
ds
stan
dard
mai
nten
ance
ra
te
167
Hypo
natr
emia
with
in 4
8 h:
Gro
up
A, 1
.72%
; Gro
up B
, 14.
3%;
Grou
p C,
3.8
%
McN
ab e
t al35
2014
3 m
o–18
yIn
clud
ed: m
edic
al, p
resu
rgic
al, r
ecru
ited
in E
D an
d pr
esur
gery
; exc
lude
d: in
itial
hy
pona
trem
ia o
r hy
pern
atre
mia
, DI,
DKA,
dia
lysi
s, in
crea
sed
rena
l sod
ium
ex
cret
ion,
pre
- and
/or
post
oper
ativ
e ne
uros
urge
ry, c
rani
ofac
ial s
urge
ry,
chem
othe
rapy
, men
ingi
tis, s
ever
e liv
er
dise
ase,
cer
tain
met
abol
ic d
isor
ders
, an
d <6
h IV
flui
ds
D 5 Pla
smaL
yte
148
D 5 0.4
5% N
aCl
690
rand
omly
as
sign
ed
(676
an
alyz
ed)
Hypo
natr
emia
: 4%
in is
oton
ic,
11%
in h
ypot
onic
with
in 7
2 h
Mon
taña
na e
t al53
2008
29 d
–18
yIn
clud
ed: P
ICU
med
ical
and
sur
gica
l; ex
clud
ed: k
idne
y fa
ilure
, ris
k of
ce
rebr
al e
dem
a, in
itial
sod
ium
<13
0 or
>15
0, >
5% d
ehyd
ratio
n; in
clud
ed
brai
n pa
thol
ogy
and
surg
ery,
car
diac
su
rger
y, a
nd a
bdom
inal
sur
gery
D 5 NaC
l 140
mEq
/L a
nd
pota
ssiu
m 1
5 m
Eq/L
D 5 sod
ium
2–4
mEq
/L/k
g pe
r 24
h (
20–1
00 m
Eq/L
)12
220
.6%
hyp
onat
rem
ia in
hy
poto
nic
grou
p ve
rsus
5.1
%
in is
oton
ic g
roup
at 2
4 h
TABL
E 3
Cont
inue
d
6
Auth
or (
Refe
renc
e)Ye
arAg
e Ra
nge
Popu
latio
nIn
terv
entio
nCo
ntro
lN
Find
ings
and
/or
Resu
lts
Nevi
lle e
t al54
2010
6 m
o–15
yIn
clud
ed: p
atie
nts
for
elec
tive
or
emer
genc
y su
rger
y; e
xclu
ded:
<8
kg, s
igni
fican
t blo
od lo
ss, s
urgi
cal
asso
ciat
ion
with
SIA
D, k
now
n AD
H se
cret
ion
abno
rmal
ity, n
ephr
ogen
ic
DI, p
ituita
ry o
r hy
poth
alam
ic d
isea
se,
kidn
ey d
isea
se, a
cute
and
/or
chro
nic
lung
dis
ease
, and
dru
gs k
now
n to
st
imul
ate
ADH
secr
etio
n
D 2.5 0
.9%
NaC
l at 1
00%
or
D 5 0.9
% N
aCl a
t 50%
m
aint
enan
ce r
ates
D 2.5 0
.45%
sal
ine
at 1
00%
m
aint
enan
ce o
r D 5
0.45
% N
aCl a
t 50%
m
aint
enan
ce r
ates
124
Sodi
um fe
ll by
>2
mEq
/L in
35
of 6
2 ch
ildre
n on
0.4
5% N
aCl
(16
of 3
1; 1
00%
) co
mpa
red
with
12
of 6
2 in
the
0.9%
NaC
l gr
oup
(3 o
f 31;
100
%; P
<
.001
) be
twee
n in
duct
ion
of
anes
thes
ia a
nd T
8
Pem
de e
t al67
a20
143
mo–
5 y
Incl
uded
: sig
n an
d sy
mpt
oms
sugg
estiv
e of
CNS
infe
ctio
n re
quir
ing
IVFs
; ex
clud
ed: i
nitia
l sod
ium
<13
5 or
>15
0,
rena
l dis
ease
, hep
atic
failu
re w
ith fl
uid
rete
ntio
n, s
hock
, dia
rrhe
a, e
ndoc
rine
di
sord
er, s
ever
e m
alnu
triti
on, a
nd
head
trau
ma
D 5 0.9
% N
aCl a
nd K
CL 2
0 m
Eq/L
D 5 0.4
5% N
aCl a
nd K
Cl 2
0 m
Eq/L
or
D 5 0.1
8% N
aCl
and
KCl 2
0 m
Eq/L
92Hy
pona
trem
ia 1
6% in
0.9
%
grou
p, 5
3% in
0.4
5% g
roup
, 65
% in
0.1
8% g
roup
Ram
anat
han
et a
l5520
162
mo–
5 y
Incl
uded
: gen
eral
ped
iatr
ic w
ard
with
sev
ere
pneu
mon
ia; e
xclu
ded:
ca
rdio
vasc
ular
com
prom
ise,
re
nal f
ailu
re, n
ephr
otic
syn
drom
e,
deco
mpe
nsat
ed c
hron
ic li
ver
dise
ase,
CHF
, dia
rrhe
a, m
enin
gitis
, on
diu
retic
s, e
ndoc
rino
path
y, s
ever
e ac
ute
mal
nutr
ition
, and
IVFs
from
tr
ansf
erri
ng h
ospi
tals
D 5 0.9
% N
aCl a
nd K
20
mEq
/LD 5 0
.18%
NaC
l and
20
mEq
/L
KCL
119
At 6
, 12,
or
24 h
, 15%
hy
pona
trem
ia in
isot
onic
ve
rsus
48%
in h
ypot
onic
flui
d gr
oup
Rey
et a
l5620
11No
cut
offs
de
fined
; IQ
R 21
–122
m
o
Incl
uded
: PIC
U m
edic
al a
nd/o
r su
rgic
al
patie
nts;
exc
lude
d: C
HF, e
lect
roly
te
alte
ratio
ns r
equi
ring
spe
cific
IVF,
rena
l fu
nctio
n ab
norm
ality
, flui
d re
stri
ctio
n,
and
pare
nter
al n
utri
tion
need
s
D 5 156
mEq
/L to
nici
ty
(sod
ium
136
mEq
/L p
lus
K, 2
0 m
Eq/L
)
D 5 50–
70 m
Eq/L
(so
dium
30
–50
mEq
/L p
lus
pota
ssiu
m 2
0 m
Eq/L
)
125
At 1
2 h:
sod
ium
leve
ls 1
33.7
±
2.7
mEq
/L in
hyp
oton
ic v
ersu
s 13
6.8
± 3
.5 m
Eq/L
in is
oton
ic
(P =
.001
)
Saba
et a
l5720
113
mo–
18 y
Incl
uded
: ED
and
post
oper
ativ
e; e
xclu
ded:
ba
selin
e so
dium
<13
3 or
>14
5; r
enal
di
seas
e, c
ardi
ac d
isea
se, h
yper
tens
ion,
on
diu
retic
s, e
dem
a, a
dren
al
dysf
unct
ion,
and
acu
te o
r se
vere
ne
urol
ogic
al d
isea
se
D 5 0.9
% N
aCl
D 5 0.4
5% N
aCl
37No
diff
eren
ce in
hyp
onat
rem
ia
but r
ate
of c
hang
e in
sod
ium
fo
r 0.
9% g
roup
was
less
in
0.4%
gro
up (
3 vs
1 m
Eq/L
) bu
t no
t sig
nific
ant;
the
0.9%
gro
up
had
sign
ifica
nt in
crea
se in
so
dium
at 1
2 h
from
bas
elin
e,
0.2
mEq
/L/h
com
pare
d w
ith
0.45
% g
roup
of 0
.08
mEq
/L
per
h
TABL
E 3
Cont
inue
d
FROM THE AMERICAN ACADEMY OF PEDIATRICS
7PEDIATRICS Volume 142, number 6, December 2018
Auth
or (
Refe
renc
e)Ye
arAg
e Ra
nge
Popu
latio
nIn
terv
entio
nCo
ntro
lN
Find
ings
and
/or
Resu
lts
Sham
in e
t al58
2014
6 m
o–12
yIn
clud
ed: i
npat
ient
, non
surg
ical
, nee
d IV
for
48 h
; exc
lude
d: s
odiu
m <
130
or >
150,
acu
te g
astr
oent
eriti
s,
hem
odyn
amic
inst
abili
ty, k
idne
y di
seas
e, c
ardi
ac d
isea
se, u
ncon
trol
led
seiz
ures
, sev
ere
deve
lopm
enta
l de
lay,
DM
, DI,
seve
re m
alnu
triti
on,
hype
rten
sion
, diu
retic
use
, ede
ma,
ad
rena
l dys
func
tion,
and
rec
ent I
VFs
D 5 0.9
% N
aCl a
nd 1
0 m
Eq/L
KC
L at
60%
mai
nten
ance
D 5 0.1
8% N
aCl a
nd 1
0 m
Eq/L
KC
L at
full
mai
nten
ance
60Hy
pona
trem
ia 3
3.3%
(n
= 10
) in
is
oton
ic g
roup
, 70%
(n
= 21
) in
hyp
oton
ic g
roup
(RR
0.4
8;
(95%
CI,
0.27
–0.8
3; P
= .0
1).
Of p
atie
nts
who
dev
elop
ed
hypo
natr
emia
, 9 h
ad v
alue
s <1
25 m
EqL
(2 in
isot
onic
and
7
in h
ypot
onic
gro
ups)
. Usi
ng
seru
m s
odiu
m le
vels
<13
5 m
Eq/L
, 25
in th
e hy
poto
nic
and
16 in
the
isot
onic
gro
up
wer
e hy
pona
trem
ic a
t 24
h (P
= .0
09);
at 4
8 h,
20
in th
e hy
poto
nic
and
6 in
th
e is
oton
ic g
roup
wer
e hy
pona
trem
ic (
P <
.001
). Hy
pern
atre
mia
at 4
8 h
in 3
IF
(P =
.27)
. Hig
her
pota
ssiu
m
at 4
8 h
in th
e IF
gro
up w
as
4.45
vs
3.63
(P
= .0
1). M
ore
acid
osis
at 4
8 h
in th
e IF
gr
oup,
7.3
2 vs
7.3
8 (P
= .0
1).
Vala
dão
et a
l6020
151–
14 y
Incl
uded
: dia
gnos
ed a
cute
app
endi
citis
an
d el
igib
le fo
r su
rgic
al tr
eatm
ent;
excl
uded
: not
des
crib
ed
Isot
onic
flui
ds (
150
mEq
/L
and
30 m
Eq/L
pot
assi
um
plus
5%
glu
cose
) at
200
0 m
L/m
2 per
24
h
Hypo
toni
c flu
ids
(30
mEq
/L
sodi
um a
nd 3
0 m
Eq/L
po
tass
ium
plu
s 5%
gl
ucos
e) a
t sam
e vo
lum
e
57Is
oton
ic: m
ean
sodi
um in
crea
se
of 1
.7 m
Eq/L
; hyp
oton
ic: m
ean
sodi
um in
crea
se o
f 1.2
mEq
/L
at 2
4 h;
at 4
8 h,
dec
reas
e of
0.
8 m
EQ/L
in b
oth
grou
psYu
ng a
nd K
eele
y5920
090.
9–15
.9 y
Incl
uded
: PIC
U m
edic
al a
nd/o
r su
rgic
al
patie
nts
expe
cted
to r
ecei
ve
mai
nten
ance
IVFs
>12
h; e
xclu
ded:
di
abet
es, r
enal
failu
re, s
hock
, and
ne
onat
es
0.9%
NS
at m
aint
enan
ce o
r re
stri
cted
rat
e4%
dex
tros
e w
ith 0
.18%
at
mai
nten
ance
or
rest
rict
ed r
ate
50Pl
asm
a so
dium
fell
in a
ll gr
oups
; flu
id ty
pe (
P =
.006
3) b
ut n
ot
rate
(P
= .1
2) w
as s
igni
fican
tly
asso
ciat
ed w
ith fa
ll in
pla
sma
sodi
um.
DI, d
iabe
tes
insi
pidu
s; D
KA, d
iabe
tic k
etoa
cido
sis;
DM
, dia
bete
s m
ellit
us; E
D, e
mer
genc
y de
part
men
t; hy
poNa
, hyp
onat
rem
ia; H
-S, H
ollid
ay-S
egar
; IF,
intr
aven
ous
fluid
; IQR
, int
erqu
artil
e ra
nge;
NS,
nor
mal
sal
ine;
RR,
rel
ativ
e ri
sk; T
PN, t
otal
par
ente
ral
nutr
ition
; T8,
8 h
aft
er e
xtub
atio
n.a
This
art
icle
was
dis
cove
red
afte
r th
e su
bcom
mitt
ee c
onve
ned
in 2
016
and
was
not
incl
uded
as
part
of t
he s
yste
mat
ic r
evie
w, F
ores
t plo
ts, o
r di
scus
sion
of r
ecom
men
datio
ns. I
t is
incl
uded
in th
e ta
ble
for
com
plet
enes
s.
TABL
E 3
Cont
inue
d
8
SUPPLEMENTAL TABLE 4 Study Appraisal for Risk of Bias
Study Bias Type
Randomization Allocation Concealment
Performance Detection Attrition Reporting Other
Almeida et al31 Low High Unclear Unclear High Low LowBrazel and McPhee48 Unclear Unclear Unclear Low Low Low LowChoong et al20 Low Low Low Low Low Low LowCoulthard et al49 Low Low Low Low Low Low LowFlores Robles and
Cuello Garcia51Low Low Unclear Low Low Low Low
Friedman et al32 Low Low Low Low Low Low LowJorro Barón et al50 Low Low Low Low Low Low LowKannan et al52 Low Low Low Low Low Low LowMcNab et al35 Low Low Low Low Low Low LowMontañana et al53 Low Low Unclear Low Low Low LowNeville et al54 Unclear Low Unclear Low Unclear Low LowRamanathan et al55 Low Low Unclear Low Low Low LowRey et al56 Low Unclear Unclear Low Low Low LowSaba et al57 Low Low Low Low Unclear Low LowShamim et al58 Low Low Unclear Low Low Low LowValadão et al60 Unclear Unclear Low Low Unclear Low LowYung and Keeley59 Low Low Low Low Low Low Low
Adapted from Higgins JP, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. Updated March 2011. London, United Kingdom: The Cochrane Collaboration; 2011. Available at: http:// handbook- 5- 1. cochrane. org/ . Accessed July 6, 2018.
