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Table 3 GRADE assessment for quality of evidence

From: Timing of pharmacologic venous thromboembolism prophylaxis initiation for trauma patients with nonoperatively managed blunt abdominal solid organ injury: a systematic review and meta-analysis

Early VTE prophylaxis compared to late VTE prophylaxis for trauma patients with nonoperatively managed blunt abdominal solid organ injury

Population: Trauma patients with nonoperatively managed blunt abdominal solid organ injury

Intervention: Early (< 48 h) VTE prophylaxis

Comparison: Late (≥ 48 h) VTE prophylaxis

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect (95% CI)

Number of participants (studies)

Certainty of evidence (GRADE)

Risk with late VTE prophylaxis

Risk with early VTE prophylaxis

Failure of NOM

10 per 1000

17 per 1000 (10 to 28)

OR 1.76 (1.01 to 3.05)

4270 (8 observational studies)

Lowa,b

Transfusion Risk

21 per 1000

32 per 1000 (12 to 87)

OR 1.56 (0.55 to 4.48)

3503 (3 observational studies)

Very lowa,c,d

DVT

28 per 1000

10 per 1000 (6 to 17)

OR 0.36 (0.22 to 0.59)

4412 (8 observational studies)

Moderatea

PE

16 per 1000

10 per 1000 (4 to 20)

OR 0.58 (0.27 to 1.25)

4412 (8 observational studies)

Lowa,d

Mortality

11 per 1000

17 per 1000 (9 to 30)

OR 1.50 (0.82 to 2.75)

3780 (6 observational studies)

Very lowa,d,e

  1. GRADE Working Group Grades of Evidence
  2. High Certainty: We are very confident that the true effect lies close to that of the estimate of the effect
  3. Moderate Certainty: We are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
  4. Low Certainty: Our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect
  5. Very Low Certainty: We have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect
  6. VTE venous thromboembolism, CI confidence interval, OR odds ratio, NOM nonoperative management, DVT deep vein thrombosis, PE pulmonary embolism
  7. *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
  8. aBias due to confounding and bias based on selection of the reported result
  9. bConfidence interval is somewhat wide and does not cross the null effect but includes appreciable risk/benefit (OR 1.25) in the confidence interval. Also, the number of events is small
  10. cSome overlap in confidence intervals across studies, but there is statistically significant, considerable heterogeneity. Also, there is some difference in the OR across studies
  11. dConfidence interval is wide as it includes OR = 1 and an appreciable risk/benefit (OR 0.75 and 1.25). Also, the number of events is small
  12. eLarge I2 and variation in effect sizes is large
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World Journal of Emergency Surgery

ISSN: 1749-7922