Table 3

Quality assessment of included studies

Study designSelection biasReporting biasConfounding
StudyRandom sequence generationAllocation concealmentSelection of two groupsBlindingBaseline characteristicsCo- interventions
Maitland et al8Randomised controlled trialLow riskLow riskLow riskLow riskLow riskLow risk
Santhanam et al14Randomised controlled trialLow riskLow riskLow riskLow riskLow riskLow risk
Carcillo et al15Prospective cohortNANAHigh risk*NAHigh risk*Unclear risk
Oliveira et al18Retrospective records reviewNANAHigh risk†NAHigh risk†Unclear risk
Han et al17Retrospective records reviewNANAHigh risk‡NAHigh risk‡Unclear risk
Carcillo et al16Prospective cohortNANALow riskNAUnclear risk§Unclear risk

  • *Compared those who received recommended APLS/PALS treatment with those who did not. ‘Received recommended APLS/PALS fluid therapy’ was defined as those who recovered regardless of fluid therapy plus those who did not recover but received >20 mg/kg of fluids. Children who did not receive recommended APLS/PALS treatment were significantly younger and had significantly longer capillary refill times, lower blood pressure and higher oxygen requirements.

  • †Compared survivors and non-survivors. The survivors were more likely to have had higher fluid volumes and were also significantly younger.

  • ‡Compared survivors and non-survivors. ‘Appropriate fluid therapy’ group includes those where fluid was given in line with ACCM/PALS guidelines AND those who recovered quickly irrespective of how much fluid was given. Non-survivors had significantly higher PRISM scores at baseline (PRISM assesses the risk of mortality).

  • §Compared those who received three different fluid regimens. Adequate baseline characteristics were not presented.

  • APLS, Advanced Paediatric Life Support; NA, not applicable; PALS, Pediatric Advanced Life support.