Understanding variations in reported epidemiology of major lower extremity amputation in the UK: a systematic review.
Understanding variations in reported epidemiology of major lower extremity amputation in the UK: a systematic review.
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DOI：
10.1136/bmjopen-2021-053599
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发表时间：
2021-10-06
期刊：
影响因子：
2.9
通讯作者：
Gray LJ
中科院分区：
文献类型：
--
作者：
Meffen A;Houghton JSM;Nickinson ATO;Pepper CJ;Sayers RD;Gray LJ
估计英国严重下肢截肢（MLEA）的患病率/发生率/数量;确定所使用的常规收集的电子健康数据的来源;评估时间趋势和区域差异;并确定报告的MLEA发生率/患病率差异的原因。系统综述和叙述性综合。检索了Medline、Embase、EMcare、CINAHL、科克伦图书馆、AMED、Scopus和灰色文献来源，检索时间为2009年1月1日至2021年8月1日。报告提供了基于人口的统计数据，使用常规收集的电子健康数据，对英国或组成国家的普通人群或糖尿病患者的成年人进行了MLEA测量。数据提取和质量评估使用乔安娜布里格斯研究所的关键评价工具进行了两个独立的审查。由于研究人群和方法学存在相当大的差异，因此无法进行数据汇总;将数据制成表格并进行叙述性综合，并讨论了研究差异。纳入了27份报告。一般人群的发病率为8.2 - 51.1/10万，糖尿病人群的发病率为70 - 291/10万。随着时间的推移，趋势的证据是混合的，但没有证据表明发病率增加。报告一致发现英格兰的地区差异，北部的发病率较高。没有研究报告患病率。数据库使用、MLEA定义、计算方法和多个手术纳入的差异，以及已识别的不准确性，可能是发生率变化的原因。英国MLEA的发病率和趋势仍不清楚;由于方法和不准确性的差异，估计值差异很大。区域差异的原因也仍然不明，流行率未经调查。需要就MLEA的定义和医疗代码清单达成国际共识。未来的研究应建议报告这些结果的标准，并进一步调查在MLEA流行病学中使用初级保健数据的潜力。PROSPERO CRD 42020165592。
Estimate the prevalence/incidence/number of major lower extremity amputations (MLEAs) in the UK; identify sources of routinely collected electronic health data used; assess time trends and regional variation; and identify reasons for variation in reported incidence/prevalence of MLEA. Systematic review and narrative synthesis. Medline, Embase, EMcare, CINAHL, The Cochrane Library, AMED, Scopus and grey literature sources searched from 1 January 2009 to 1 August 2021. Reports that provided population-based statistics, used routinely collected electronic health data, gave a measure of MLEA in adults in the general population or those with diabetes in the UK or constituent countries were included. Data extraction and quality assessment using the Joanna Briggs Institute Critical Appraisal Instruments were performed by two reviewers independently. Due to considerable differences in study populations and methodology, data pooling was not possible; data were tabulated and narratively synthesised, and study differences were discussed. Twenty-seven reports were included. Incidence proportion for the general population ranged from 8.2 to 51.1 per 100 000 and from 70 to 291 per 100 000 for the population with diabetes. Evidence for trends over time was mixed, but there was no evidence of increasing incidence. Reports consistently found regional variation in England with incidence higher in the north. No studies reported prevalence. Differences in database use, MLEA definition, calculation methods and multiple procedure inclusion which, together with identified inaccuracies, may account for the variation in incidence. UK incidence and trends in MLEA remain unclear; estimates vary widely due to differences in methodology and inaccuracies. Reasons for regional variation also remain unexplained and prevalence uninvestigated. International consensus on the definition of MLEA and medical code list is needed. Future research should recommend standards for the reporting of such outcomes and investigate further the potential to use primary care data in MLEA epidemiology. PROSPERO CRD42020165592.
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