目的:回顾目前可用的或正在开发的决策辅助工具,以预测患者的外头版本(ECV)成功的几率。
方法:我们搜索了PubMed/MEDLINE,CochraneCentral,以及2015-2022年的ClinicalTrials.gov。还包括2015年前系统审查的文章。我们选择了描述或评估模型(预测规则)的英文文章,旨在预测单个患者的ECV结果。可接受的模型结果包括ECV尝试后的头颅表现以及ECV是否最终导致阴道分娩。两位作者根据PRISMA2020指南独立进行了文章选择。自2015年以来,380个独特的记录进行了标题和摘要筛选,49份报告进行了全文审查。最终,包括17篇新文章和8篇来自先前审查的文章。在25篇文章中,22个提出的1-2个模型,每个模型总共25个,而其余3篇文章验证了以前的模型,没有提出新的模型。
结果:在17篇新文章中,10低,6中度,和1高风险的偏见。几乎所有文章都来自欧洲(11/25)或亚洲(10/25);在过去的20年中,只有一项研究来自美国。发现的模型有不同的演示文稿,包括得分图,决策树(流程图),和方程式。大多数(13/25)没有任何形式的验证,只有5/25达到了外部验证。只有纽曼-孔雀模型(美国,1993)被反复外部验证(巴基斯坦,2012年葡萄牙,2018)。大多数模型(14/25)是在过去5年中发布的。总的来说,较新的型号设计得更坚固,使用更大的样本量,数学上更严格。因此,尽管他们等待进一步的验证,这些模型有很大的潜力比纽曼-孔雀模型更具预测性。
结论:只有Newman-Peacock模型可以正常临床使用。许多较新的模型很有希望,但需要进一步验证。
To review the decision aids currently available or being developed to predict a patient\'s odds that their external cephalic version (ECV) will be successful.
We searched PubMed/MEDLINE, Cochrane Central, and ClinicalTrials.gov from 2015 to 2022. Articles from a pre-2015 systematic review were also included. We selected English-language articles describing or evaluating models (prediction rules) designed to predict an outcome of ECV for an individual patient. Acceptable model outcomes included cephalic presentation after the ECV attempt and whether the ECV ultimately resulted in a vaginal delivery. Two authors independently performed article selection following PRISMA 2020 guidelines. Since 2015, 380 unique records underwent title and abstract screening, and 49 reports underwent full-text review. Ultimately, 17 new articles and 8 from the prior review were included. Of the 25 articles, 22 proposed one to two models each for a total of 25 models, while the remaining 3 articles validated prior models without proposing new ones.
Of the 17 new articles, 10 were low, 6 moderate, and 1 high risk of bias. Almost all articles were from Europe (11/25) or Asia (10/25); only one study in the last 20 years was from the United States. The models found had diverse presentations including score charts, decision trees (flowcharts), and equations. The majority (13/25) had no form of validation and only 5/25 reached external validation. Only the Newman-Peacock model (United States, 1993) was repeatedly externally validated (Pakistan, 2012 and Portugal, 2018). Most models (14/25) were published in the last 5 years. In general, newer models were designed more robustly, used larger sample sizes, and were more mathematically rigorous. Thus, although they await further validation, there is great potential for these models to be more predictive than the Newman-Peacock model.
Only the Newman-Peacock model is ready for regular clinical use. Many newer models are promising but require further validation.
· 25 ECV prediction models have been published; 14 were in the last 5 years.. · The Newman-Peacock model is currently the only one with sufficient validation for clinical use.. · Many newer models appear to perform better but await further validation..