Beaule Paul E, Shea Beverley, Abedlbary Hesham, Ahmadzai Nadera, Skidmore Becky, Mallick Ranjeeta, Hutton Brian, Bunting Alexandra C, Moran Julian, Ward Roxanne, Moher David
Division of Orthopaedic Surgery, University of Ottawa, 501 Smyth Rd., Ottawa, ON, K1H 8L6, Canada.
Knowledge Synthesis Group, Ottawa Hospital Research Institute, Center for Practice-Changing Research, 501 Smyth Rd., Ottawa, ON, K1H 8L6, Canada.
Syst Rev. 2015 Nov 2;4:148. doi: 10.1186/s13643-015-0124-1.
Total joint replacement (TJR) procedures have been one of the most rewarding interventions for treating patients suffering from joint disease. However, developing a periprosthetic joint infection (PJI) is a serious complication that is associated with the highest burden of cost and reduction in patients' quality of life compared to other complications following TJRs. One of the main challenges facing clinicians who are treating PJIs is accurately diagnosing infection in a timely fashion. Multiple orthopedic associations have published clinical guidelines for diagnosing PJI which are based solely on consensus approaches, expert opinions, and narrative reviews. We believe that a higher quality of scientific rigor is necessary to establish a diagnostic guideline that represents current evidence more accurately and that identifies important knowledge gaps in PJI diagnosis. Therefore, we will conduct a systematic review on diagnostic performance of blood markers, synovial fluids, and tissue tests for diagnosing PJI.
METHODS/DESIGN: Electronic search strategies will be developed and tested by an experienced medical information specialist in consultation with the review team, and gray literature will be searched using the checklist from CADTH's Grey Matters Light. Two reviewers will independently screen the literature for inclusion using the prespecified eligibility criteria. Non-English language and animal-only studies will be excluded. Quality assessment and data extractions by reviewers will be verified, and disagreements will be resolved through consensus or third party adjudication. We will assess the quality of individual studies using the QUADAS-2 tool and use GRADE to summarize the strength of body of evidence. Analyses of evidence will be conducted in accordance with the Cochrane Handbook for Diagnostic Test Accuracy Reviews.
We will conduct a systemic review of tests (blood markers, synovial fluids, and tissue testing) for diagnosing PJI in patients' knee, hip, and shoulder joint replacements. This will be the first scientifically rigorous and comprehensive systematic review in the field and may feed into an evidence-based clinical practice guideline. We will compare the findings of this review with the consensus-based guides and discuss the differences, similarities, and knowledge gaps.
PROSPERO CRD42015023768.
全关节置换术（TJR）一直是治疗关节疾病患者最有成效的干预措施之一。然而，发生假体周围关节感染（PJI）是一种严重的并发症，与其他全关节置换术后并发症相比，其成本负担最高，且会降低患者的生活质量。治疗假体周围关节感染的临床医生面临的主要挑战之一是及时准确地诊断感染。多个骨科协会已发布了诊断假体周围关节感染的临床指南，这些指南仅基于共识方法、专家意见和叙述性综述。我们认为，需要更高质量的科学严谨性来建立一个能更准确地反映当前证据并识别假体周围关节感染诊断中重要知识空白的诊断指南。因此，我们将对血液标志物、滑液和组织检测在诊断假体周围关节感染方面的诊断性能进行系统评价。
方法/设计：由经验丰富的医学信息专家与综述团队协商制定并测试电子检索策略，并使用加拿大药物和卫生技术局（CADTH）的《灰色文献简编》清单检索灰色文献。两名评审员将使用预先指定的纳入标准独立筛选文献以确定是否纳入。非英语语言研究和仅涉及动物的研究将被排除。评审员进行的质量评估和数据提取将得到核实，分歧将通过协商一致或第三方裁决解决。我们将使用QUADAS - 2工具评估个体研究的质量，并使用GRADE总结证据的强度。证据分析将按照《Cochrane诊断试验准确性综述手册》进行。
我们将对用于诊断膝关节、髋关节和肩关节置换患者假体周围关节感染的检测方法（血液标志物、滑液和组织检测）进行系统评价。这将是该领域首个科学严谨且全面的系统评价，可能为基于证据的临床实践指南提供参考。我们将把本综述的结果与基于共识的指南进行比较，并讨论差异、相似之处和知识空白。
PROSPERO CRD42015023768
