小儿喉气管重建的疗效评估：国际共识声明
Outcome measures for pediatric laryngotracheal reconstruction: International consensus statement.
作者信息
Balakrishnan Karthik, Sidell Douglas R, Bauman Nancy M, Bellia-Munzon Gaston F, Boesch R Paul, Bromwich Matthew, Cofer Shelagh A, Daines Cori, de Alarcon Alessandro, Garabedian Nöel, Hart Catherine K, Ida Jonathan B, Leboulanger Nicolas, Manning Peter B, Mehta Deepak K, Monnier Philippe, Myer Charles M, Prager Jeremy D, Preciado Diego, Propst Evan J, Rahbar Reza, Russell John, Rutter Michael J, Thierry Briac, Thompson Dana M, Torre Michele, Varela Patricio, Vijayasekaran Shyan, White David R, Wineland Andre M, Wood Robert E, Wootten Christopher T, Zur Karen, Cotton Robin T
机构信息
Department of Otorhinolaryngology and Mayo Clinic Children's Center, Rochester, Minnesota.
Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California.
出版信息
Laryngoscope. 2019 Jan;129(1):244-255. doi: 10.1002/lary.27445. Epub 2018 Aug 27.
OBJECTIVES
Develop multidisciplinary and international consensus on patient, disease, procedural, and perioperative factors, as well as key outcome measures and complications, to be reported for pediatric airway reconstruction studies.
METHODS
Standard Delphi methods were applied. Participants proposed items in three categories: 1) patient/disease characteristics, 2) procedural/intraoperative/perioperative factors, and 3) outcome measures and complications. Both general and anatomic site-specific measures were elicited. Participants also suggested specific operations to be encompassed by this project. We then used iterative ranking and review to develop consensus lists via a priori Delphi consensus criteria.
RESULTS
Thirty-three pediatric airway experts from eight countries in North and South America, Europe, and Australia participated, representing otolaryngology (including International Pediatric Otolaryngology Group members), pulmonology, general surgery, and cardiothoracic surgery. Consensus led to inclusion of 19 operations comprising open expansion, resection, and slide procedures of the larynx, trachea, and bronchi as well as three endoscopic procedures. Consensus was achieved on multiple patient/comorbidity (10), disease/stenosis (7), perioperative-/intraoperative-/procedure-related (16) factors. Consensus was reached on multiple outcome and complication measures, both general and site-specific (8 general, 13 supraglottic, 15 glottic, 17 subglottic, 8 cervical tracheal, 12 thoracic tracheal). The group was able to clarify how each outcome should be measured, with specific instruments defined where applicable.
CONCLUSION
This consensus statement provides a framework to communicate results consistently and reproducibly, facilitating meta-analyses, quality improvement, transfer of information, and surgeon self-assessment. It also clarifies expert opinion on which patient, disease, procedural, and outcome measures may be important to consider in any pediatric airway reconstruction patient.
LEVEL OF EVIDENCE
5 Laryngoscope, 129:244-255, 2019.
目的
就小儿气道重建研究应报告的患者、疾病、手术及围手术期因素，以及关键结局指标和并发症达成多学科和国际共识。
方法
采用标准德尔菲法。参与者提出了三类项目：1）患者/疾病特征，2）手术/术中/围手术期因素，3）结局指标和并发症。征集了一般指标和特定解剖部位的指标。参与者还建议了本项目应涵盖的具体手术。然后，我们通过先验德尔菲共识标准，采用迭代排序和评审来制定共识清单。
结果
来自北美洲、南美洲、欧洲和澳大利亚八个国家的33名小儿气道专家参与了研究，他们分别代表耳鼻喉科（包括国际小儿耳鼻喉科小组成员）、肺病学、普通外科和心胸外科。通过共识，纳入了19种手术，包括喉、气管和支气管的开放扩张、切除及滑行手术以及三种内镜手术。就多种患者/合并症（10项）、疾病/狭窄（7项）、围手术期/术中/手术相关（16项）因素达成了共识。就多种一般和特定部位的结局及并发症指标达成了共识（8项一般指标、13项声门上指标、15项声门指标、17项声门下指标、8项颈段气管指标、12项胸段气管指标）。该小组能够阐明每种结局应如何测量，并在适用时定义了具体的工具。
结论
本共识声明提供了一个框架，以一致且可重复的方式交流结果，促进荟萃分析、质量改进、信息传递和外科医生自我评估。它还阐明了专家意见，即在任何小儿气道重建患者中，哪些患者、疾病、手术及结局指标可能需要重点考虑。
证据级别
5 《喉镜》，129:244 - 255，2019年。
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