Asystematic Literature Search Research Articles

Allergen immunotherapy for rare allergens

Among allergies to aeroallergens, approximately 20% are allotted to the so-called rare allergens. These include ash pollen, weed pollen, storage mites, molds, and animal allergens. The prevalences of allergies to these allergens are lower, but affected patients also suffer considerably from their "rare" allergy. Hence, these allergies should neither be overseen nor completely forgotten in daily practice. Especially mold, mite, and animal allergens often induce asthma, so that the significance of allergen-specific immunotherapy (AIT) should not be neglected in causal therapy. This work summarizes the current state of knowledge on the groups of rare aeroallergens in terms of characteristics, prevalences, and data on AIT. It is based on asystematic literature search performed in the MEDLINE (PubMed®) and Google Scholar databases. AIT preparations for rare allergens are classified as individual formulations and are not subject to the German Therapy Allergen Ordinance. Due to the low case numbers, the levels of evidence for these formulations are not as high as those for dust mites, grass, or birch pollen, but exhibit good efficacy in practical experience.

Post-resuscitation talk in the intensive care unit : Living interprofessionalism-amust have!

In the context of medical care, healthcare professionals are confronted with cardiopulmonary resuscitation, which can have long-term effects on the participants. The aim was to develop, implement, and evaluate aprotocol-supported post-resuscitation talk for practice in the intensive care unit of auniversity hospital. Within the evidence-based nursing working group, university-qualified nurses performed asystematic literature search in CareLit (hpsmedia, Hungen, Germany), the Cochrane Library (Cochrane, London, England), LIVIVO (Deutsche Zentralbibliothek für Medizin, Cologne, Germany), and PubMed/MEDLINE (U.S. National Library of Medicine, Bethesda, MD, USA) as well as using the snowball principle. Based on the results, the post-resuscitation talk and adebriefing protocol were developed and consented in amultiprofessional team. Additionally, aquestionnaire to analyze the current situation (t0) and evaluate the implementation (t1) was developed. Implementation of the post-resuscitation talk was conducted from August 2021. The t0 survey took place from June to July 2021 and for t1 from February to March 2022. In t0, fewer interprofessional reflections were carried out after resuscitations in the category always or frequently (17.5%, n = 7) than in t1 (50.0%, n = 13). The rate of initiated improvement interventions was increased (t0: 24.3%, n = 9 vs. t1: 59.1%, n = 13). The results show promotion of multiprofessional collaboration in t0 and t1, and potential for optimization in the debriefing protocol in t1. Implementation of apost-resuscitation talk in hospitals is auseful tool for the structured interprofessional follow-up of resuscitation events. The results demonstrated initial positive effects and potential for optimization.

Radiofrequency denervation of the spine and the sacroiliac joint : Asystematic literature search according to GRADE with newGerman S3 guideline

This article summarizes the results of the German guideline on radiofrequency denervation of the facet joints and the sacroiliac joint. Evidence on the indications, test blocks and technical parameters are presented. The aim is to avoid overtreatment and undertreatment, which is also of socioeconomic importance. Asystematic evaluation of the literature was carried out according to the grading of recommendations assessment, development and evaluation (GRADE) approach. Amultidisciplinary guideline group has developed recommendations and statements. Statements and recommendations were given for 20key questions. There was an 87.5% consensus for 1 recommendation and 100% consensus for all other recommendations and statements. The guideline was approved by all scientific medical societies involved. Specific questions included the value of the medical history, examination and imaging, the need for conservative treatment prior to an intervention, the importance of test blocks (medial branch block and lateral branch block), choice of imaging for denervation, choice of trajectory, the possibility to influence the size of the lesion, stimulation, the possibility of revision, sedation and decision support for patients with anticoagulants, metal implants and pacemakers and advice on how to avoid complications. Selected patients can benefit from well-performed radiofrequency denervation. The guideline recommendations are based on very low to moderate quality of evidence.

Comparison of different prediction models for the occurrence of nausea and vomiting in the postoperative phase : Asystematic qualitative comparison based on prospectively defined quality indicators

Various prognostic prediction models exist for evaluating the risk of nausea and vomiting in the postoperative period (PONV). So far, no systematic comparison of these prognostic scores is available. Asystematic literature search was carried out in seven medical databases to find publications on prognostic PONV models. Identified scores were assessed against prospectively defined quality criteria, including generalizability, validation and clinical relevance of the models. The literature search revealed 62relevant publications with atotal of 81,834 patients which could be assigned to 8prognostic models. The simplified Apfel score performed best, primarily because it was extensively validated. The Van den Bosch score and Sinclair score tied for second place. The simplified Koivuranta score was in third place. The qualitative analysis highlights the strengths and weaknesses of each prediction system based on predetermined standardized quality criteria.

Efficacy of internet-based interventions for depression available in Germany-Asystematic review and meta-analysis

Internet-based interventions (IBIs) for the treatment of depression have been found to have positive effects in international meta-analyses; however, it is unclear whether these effects also extend to IBIs specifically available in Germany. The aim of this meta-analysis was to estimate the immediate effects and the long-term effects of IBIs available in Germany free of charge or available on prescription and covered by the public health insurances as so-called digital health applications (DiGAs) and to compare the efficacy of DiGAs and freely available IBIs. Asystematic literature search and random-effects meta-analysis were performed (preregistration: INPLASY202250070). Randomized controlled trials (RCTs) of IBIs freely available in Germany or as DiGA in adults with elevated depressive symptoms were compared with active and inactive controls available at the time of the survey in May 2022. Atotal of six interventions were identified: COGITO, deprexis, iFightDepression, moodgym, Novego, and Selfapy. The pooled effect size of atotal of 28studies with 13,413 participants corresponded to an effect of Cohen'sd = 0.42, (95% confidence interval, CI: 0.31-0.54, I2 = 81%). The analysis of long-term effects showed asmaller effect size of d = 0.29, (95% CI: 0.21-0.37, I2 = 22%, N = 10). Subgroup analyses indicated apossible superiority of the three interventions listed in the DiGA directory (d = 0.56, 95% CI: 0.38-0.74, I2 = 83%, N = 15) compared to the three freely available IBIs (d = 0.24, 95% CI: 0.14-0.33, I2 = 44%, N = 13, p = 0.002). The IBIs for depressive disorders available in Germany are effective and can therefore be used in the treatment of people with adepressive disorder; however, it is possible that not all interventions are equally effective.

Short paths to diagnosis with artificial intelligence: systematic literature review on diagnostic decision support systems

Rare diseases are often recognized late. Their diagnosis is particularly challenging due to the diversity, complexity and heterogeneity of clinical symptoms. Computer-aided diagnostic aids, often referred to as diagnostic decision support systems (DDSS), are promising tools for shortening the time to diagnosis. Despite initial positive evaluations, DDSS are not yet widely used, partly due to alack of integration with existing clinical or practice information systems. This article provides an insight into currently existing diagnostic support systems that function without access to electronic patient records and only require information that is easily obtainable. Asystematic literature search identified eight articles on DDSS that can assist in the diagnosis of rare diseases with no need for access to electronic patient records or other information systems in practices and hospitals. The main advantages and disadvantages of the identified rare disease diagnostic support systems were extracted and summarized. Symptom checkers and DDSS based on portrait photos and pain drawings already exist. The degree of maturity of these applications varies. DDSS currently still face anumber of challenges, such as concerns about data protection and accuracy, and acceptance and awareness continue to be rather low. On the other hand, there is great potential for faster diagnosis, especially for rare diseases, which are easily overlooked due to their large number and the low awareness of them. The use of DDSS should therefore be carefully considered by doctors on acase-by-case basis.

Effects of whole-body vibration therapy on pain, functionality, postural stability, and proprioception in patients with subacute and chronic non-specific low back pain: asystematic review.

Non-specific low back pain (NLBP) is acommon and clinically significant condition with substantial socioeconomic implications. Whole-body vibration therapy (WBVT) has shown effectiveness in improving pain and sensorimotor function (e.g., in osteoporosis) in previous studies. However, studies had heterogeneous settings. The aim of this study was to assess the effects of WBVT on pain, function, proprioception, and postural stability in patients with subacute and chronic NLBP. Asystematic literature search was conducted in the scientific databases PubMed, EMBASE, and PEDro (from inception until 17.05.2023). Only prospective controlled and uncontrolled studies were included. Outcome measures assessed were pain intensity, function (activities of daily living and physical function), proprioception, and postural stability. Atotal of 12 original articles (n = 821) were included in the analysis. Ten of the studies were randomized controlled trials, one study had acrossover design, and one study had aone-group pre-post study design. The studies compared WBVT vs. no intervention, WBVT vs. basic physical therapy, WBVT vs. core stabilization exercises with and without respiratory resistance, WBVT vs. lumbar extension exercises, and WBVT vs. whole body electromyostimulation training. The treatment approaches varied in terms of duration (2-18weeks), frequency (2-3times per week, two applications with a2-week break), vibration frequency (5-30 Hz), type of exercises (WBVT with or without static or dynamic exercises), and vibration direction (horizontal and vertical). Significant pain reduction was observed in all 10studies that investigated pain levels. Significant improvement in daily activity function was reported in five of the six studies that investigated daily function, while improvement in physical function was observed in all four studies that investigated physical function. Improvement in proprioception was reported in all three studies that investigated proprioception, and significant improvement in postural stability was observed in four out of six studies that investigated postural stability. No adverse events or side effects related to WBVT were reported. The majority of the included studies demonstrated significant pain reduction, improvement in physical and daily functioning, and enhanced proprioception. Improvement in postural stability was less consistent. WBVT appears to be asafe and effective treatment modality for subacute and chronic NLBP when used within amultimodal approach. Future research should focus on standardized settings including assessment methods, treatment regimens, frequencies, and intensities.

Assessment of interactions and dosage recommendations of synthetic DMARDs-Evidence-based and consensus-based recommendations based on asystematic literature search.

Conventional synthetic (cs) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARD) have potential interactions with amultitude of drugs. Furthermore, they sometimes have a lower therapeutic index, particularly in cases of limited organ functions. The aim of this work was to establish evidence-based recommendations on the therapeutic use of DMARDs in the context of drug interactions and dosage recommendations. Asystematic literature search was carried out on the issue of drug interactions and dosages in cases of patients with limited kidney function and higher age and suffering from rheumatoid arthritis. Atotal of 2756 scientific publications were screened and 154 selected of which 68 were scrutinized in detail. Furthermore, the respective product information was also analyzed. Amultitude of possible interactions of synthetic DMARDs with different drugs were detected, which were then assessed with respect to the clinical significance and consequences. Aconsensus process led to making recommendations with which the interactions were classified: A:dangerous combination, B:avoid combination (if possible, pausing DMARD treatment), C:possible combination requiring increased monitoring and potential adjustments in dosage and D:pharmacological interaction without relevance in DMARD standard doses. Apart from that dosage recommendations were established for each csDMARD and tsDMARD depending on kidney function and age. There are 3primary recommendations and 11core recommendations on interactions and dosages of csDMARDs and tsDMARDs meant as apractical help for therapeutic decision making and to improve safety in the treatment of rheumatoid arthritis.

Personalized psychotherapy of posttraumatic stress disorder : Overview on the selection of treatment methods and techniques using statistical procedures

Arelevant heterogeneity of treatment effects in posttraumatic stress disorder (PTSD) is discussed with respect to the debate about the necessity of phase-based treatment and in light of the new diagnosis of complex PTSD and has recently been proven; however, there has been little personalization in the treatment of PTSD. This article presents the current state of research on the personalized selection of specific psychotherapeutic methods for the treatment of PTSD based on patient characteristics using statistical methods. Asystematic literature search was conducted in the PubMed (including Medline), Embase, Web of Science Core Collection, Google Scholar, PsycINFO and PSYNDEX databases to identify clinical trials and reviews examining personalized treatment for PTSD. A total of 13relevant publications were identified, of which 5articles were predictor analyses in samples without control conditions and 7articles showed analyses of randomized controlled trials (RCT) with apost hoc comparison of treatment effects in optimally and nonoptimally assigned patients. In addition, one article was asystematic review on the treatment of patients with comorbid borderline personality order and PTSD. The available manuscripts indicate the importance and benefits of personalized treatment in PTSD. The relevant predictor variables identified for personalization should be used as asuggestion to investigate them in future prospective studies.

Development of the new guidelines on osteoporosis : Methodological and content development

Since 2018, the present S3guideline Prophylaxis, Diagnosis and Therapy of Osteoporosis (AWMF 183-001) has been updated following aprevious update of the underlying PICO questions (Population-Intervention-Comparison-Outcome questions) for asystematic literature search. The focus of the guideline update, in addition to updating the evidence supporting literature along with recommendations, was the development of arisk calculator for vertebral fractures and femoral neck fractures. This is essential for managing risk assessment because of the multitude of risk factors that contribute to fracture risk. This article considers the development of the guideline update methodologically and substantively, the latter by reflecting on the core themes of the guideline update.

Pediatric inpatient interdisciplinary multimodal pain treatment in Germany

Severely disabling chronic pain affects approximately half amillion children in Germany. If there is a lack of response to unimodal treatment, an inpatient interdisciplinary multimodal pain treatment (IMPT) can be considered. This review article describes the supply situation of pediatric inpatient IMPT in Germany and presents the current evidence on the effectiveness. Based on asystematic literature search, studies addressing the effectiveness of pediatric inpatient IMPT in Germany were identified. In addition, further sources were used to extract information on pediatric IMPT treatment centers in Germany in order to describe the treatment approaches, the qualification of personnel and characteristics of patients. There are four pediatric pain centers in Germany that are specialized in inpatient IMPT for children and adolescents. Treatment duration ranges between 3 and 4weeks. The multimodal treatment is carried out by amultiprofessional team and is generally available for patients up to 18years. The majority of patients are female. The effectiveness of pediatric IMPT in Germany was investigated up to 4years after treatment. Positive effects were shown for pain characteristics and also for the emotional burden. Additional treatment modules can facilitate further optimization of treatment effects. Further research on the effectiveness of IMPT in Germany is important in order to refine and optimize the available treatment programs.

Digitalization in rehabilitation

The term digitalization is in trend. In addition to modernizing existing structures and converting analogue to digital processes, there are now alarge number of digital applications available in the medical field. This is also increasingly influencing prehabilitation and rehabilitation. The aim of this article is to provide an overview of digitalization options in the field of rehabilitation, taking the current literature into account. Asystematic literature search was carried out on the topic of digitalization in rehabilitation, especially in relation to interventions and diseases of the knee joint, using among others PubMed and PEDro. Having arrived in "Rehabilitation4.0", the networking of all infrastructures as well as the increasing use of artificial intelligence, the individualization of offers for healthcare companies and patients are playing an increasing role and are experiencing areal hype due to the supposedly infinite possibilities; however, the data situation on various digital offers in rehabilitation is inconsistent. The digital transformation provides many opportunities and challenges for rehabilitation, but despite all the euphoria it has to be critically questioned.

Delirium in stroke: systematic review and meta-analysis

Due to the complexity of the symptoms, delirium detection poses achallenge in stroke patients. Alarge body of literature has established that neurospecific challenges can have aconsiderable impact on diagnosis and are underrepresented in screening. An analysis of current scientific literature on delirium screening tests and their applicability in stroke patients, acknowledging neurospecific challenges and evaluating diagnostic test accuracy. Asystematic literature search was conducted in PubMed, CINAHL, and Cochrane Library databases. Studies published between 2018 and 2021 were evaluated and the study quality was assessed according to the Institute for Clinical Systems Improvement. Furthermore, the specificity and sensitivity of delirium screening tests were pooled RESULTS: The systematic literature review found atotal of 2636articles, following areview of the inclusion and exclusion criteria. Thus, 18moderate-quality studies with atotal of 3320patients and 9distinct delirium screenings were identified. Within those 18studies, the prevalence of delirium was 34.2%. However, the delirium prevalence was significantly lower in 6studies that included patients with neurologic impairments (26.5 vs. 32.1%, p = 0.0004). Pooled sensitivity and specificity for the 4AT (Rapid assessment test for delirium ) were 82 and 77%, while these values were 72 and 93% for the CAM-ICU (Confusion Assessment Method for Intensive Care Units) and 79 and 72% for the ICDSC (Intensive Care Delirium Screening Checklist). Neurological impairments may influence the test quality of delirium screening in stroke patients. The CAM-ICU can be recommended for nonaphasic patients. The ICDSC can be used in all stroke patients on stoke units with an adjusted cut-off value of > 5points.

DIVI-Recommendations on the infrastruture of adult intensive care units

This document on the Structure and Equipment for Intensive Care Units of the German Association for Intensive and Emergency Care (DIVI) aims at providing guidance and recommendations for the requirements of (infra)structure, personal, and organization of intensive care units. The recommendations are based on asystematic literature search and aformal consensus process from agroup of multi-disciplinary and multiprofessional specialists from the DIVI. The recommendations comprise a3-staged level of intensive care units, a3-staged level of care with respect to severity of illness, the staffing requirement of physicians, nurses, physiotherapists, pharmacists, psychologists, and other specialists. Furthermore, proposals concerning the equipment and the construction of ICUs are supplied.

Who is afraid of Ockham's razor? : Adiscourse analysis on resilience in palliative care (2000-2021)

The concept of resilience is becoming increasingly disseminated from material science into various fields of science. It is infiltrating medical fields predominantly via psychology and is also recommended for coping with the special burdens in pain management and palliative care. Aprecise definition of the term and its operationalization pose problems. Acritical stocktaking of the use of this term in the discourse of palliative care research. Analytical discourse analysis of atext corpus from palliative medical care publications in the time period from 2000 to 2021, obtained by means of asystematic literature search. In the research discourse of palliative care, resilience is atopic primarily as astrategy for self-optimization of employees (e.g., burnout prophylaxis with the aim of preserving the workforce). Only rarely does the question of whether it offers potential for patients and their families take center stage, and then more as acatchword than as aconcrete concept. The reason is that there is so far no adequate operationalization of the concept of resilience. Furthermore, there is alack of sufficient justification for the relevance of the concept in patient care of palliative medicine. There is alack of qualified contributions of palliative research to the metadiscourse about resilience, especially in the context of affected patients. A successful operationalization of the term requires a highly complex multidimensionality of the palliative path of an interdisciplinary approach. There is alack of ethical standards that prevent an affirmative instrumentalizing application of the term.

Do we need to treat asymptomatic bacteriuria in immunocompromised patients? : Arapid review

Antimicrobial resistance (AMR), especially multidrug resistant Escherichiacoli strains, is aproblem even in Europe. That is why inadequate usage of antibiotic therapy should be avoided, especially in the treatment of asymptomatic bacteriuria (ASB). Should ASB be treated with antibiotics in immunocompromized patients, namely solid organ transplant, especially kidney transplant or stem cell transplant recipients? Arapid review based on asystematic literature search in MEDLINE between 1980 and 2022 was performed. For evidence synthesis, only randomized controlled trials (RCTs) or quasi-RCTs were considered. No studies were identified for the search term solid organ and stem cell transplantation. Three RCTs (antibiotic therapy versus no therapy) were included for adult kidney transplantation. None of the studies showed abenefit for antibiotic therapy of ASB in reduction of symptomatic urinary tract infections, especially in the late transplantation phase two months after kidney transplantation; furthermore, this therapy may promote AMR development. In addition, there are numerous gaps of evidence, e.g., in pediatric transplantation or regarding the influence of special immunosuppressants. There is no evidence for antibiotic therapy of ASB in adult kidney transplantation two months after the surgery. Further studies addressing the identified evidence gaps are essential for the prevention of further AMR development.

Effects of lithium, valproic acid, carbamazepine and antipsychotic agents on cognition in bipolar disorders-A systematic review

Until now the long-term consequences of the medical treatment for bipolar disorder have barely been examined, especially the consequences with respect to cognitive impairment and dementia. Some studies show signs that some treatment options have abetter effect on the brain than others. This review summarizes the current state of research. The effects of long-term consequences of lithium, valproic acid, carbamazepine and antipsychotic agents on the development of dementia or cognitive impairments in patients with bipolar disorder were investigated. Asystematic literature search was carried out in the PubMed data base from May to July 2022. The majority of studies showed that lithium has aneuroprotective effect and can lower the risk of developing dementia, whereas an increased risk was found in patients taking valproic acid. There are only very few studies that deal with antipsychotic medication and the long-term consequences concerning dementia. Lithium should be recommended for the long-term treatment of bipolar disorder. Valproic acid should not or carefully be used as it can affect the risk of developing dementia. With respect to antipsychotics there is no recommendation as more studies are needed to evaluate the long-term consequences.

Assessment of interactions and dosage recommendations of synthetic DMARDs-Evidence-based and consensus-based recommendations based on asystematic literature search

Conventional synthetic (cs) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARD) have potential interactions with amultitude of drugs. Furthermore, they sometimes have a lower therapeutic index, particularly in cases of limited organ functions. The aim of this work was to establish evidence-based recommendations on the therapeutic use of DMARDs in the context of drug interactions and dosage recommendations. Asystematic literature search was carried out on the issue of drug interactions and dosages in cases of patients with limited kidney function and higher age and suffering from rheumatoid arthritis. Atotal of 2756 scientific publications were screened and 154 selected of which 68 were scrutinized in detail. Furthermore, the respective specialist subject information was also analyzed. Amultitude of possible interactions of synthetic DMARDs with different drugs were detected, which were then assessed with respect to the clinical significance and consequences. Aconsensus process led to making recommendations with which the interactions were classified: A:dangerous combination, B:avoid combination (if possible, pausing DMARD treatment), C:possible combination requiring increased monitoring and potential adjustments in dosage and D:pharmacological interaction without relevance in DMARD standard doses. Apart from that dosage recommendations were established for each csDMARD and tsDMARD depending on kidney function and age. There are 3primary recommendations and 11core recommendations on interactions and dosages of csDMARDs and tsDMARDs meant as apractical help for therapeutic decision making and to improve safety in the treatment of rheumatoid arthritis.

Clinical efficacy of auricular vagus nerve stimulation in the treatment of chronic and acute pain : Asystematic review

Current guidelines recommend apersonalized, multimodal, and interdisciplinary approach for the treatment of chronic pain. Already in the acute treatment of postoperative pain, it can be useful to minimize risk factors for chronification. Auricular vagus nerve stimulation (aVNS) could be an effective non-drug therapy for the treatment of chronic and acute pain. The aim of this systematic review is to evaluate the clinical efficacy of aVNS in chronic and acute pain as well as its effect on medication intake. Asystematic literature search was carried out on the application of auricular electrical stimulation in chronic and acute pain. Studies were classified according to their level of evidence and evaluated via the Jadad scale as well as their scientific validity, and then analyzed in terms of indication, method, stimulation parameters, duration of treatment, efficacy, and safety. Twenty studies on chronic pain indications, ten studies on acute postoperative pain, as well as seven studies on experimental acute pain were identified and analyzed. The search revealed atotal of n = 1105 aVNS-treated patients. The best evidence on the efficacy of aVNS is available for the indications chronic low back pain, chronic cervical syndrome, chronic abdominal pain, and chronic migraine as well as acute postoperative pain in oocyte aspiration, laparoscopic nephrectomy, and open colorectal surgery. Additionally asignificant reduction in analgesic or opiate intake was evident in most studies. In three randomized controlled trials in chronic pain patients, asustainable pain reduction over aperiod of up to 12months was shown. Overall, aVNS was very well tolerated. This review indicates that aVNS can be acomplementary and effective non-drug treatment for patients with chronic and acute postoperative pain. Future studies in these indications should focus on standardizing and optimizing treatment parameters, inclusion of quality-of-life outcome parameters, and longer follow-up periods to better understand the sustainable therapeutic effect of aVNS.

Mechanical Thrombectomy for Pediatric Large Vessel Occlusions : ASystematic Review and Meta-analysis.

Acute intracranial large vessel occlusion (LVO) is an important cause of morbidity and mortality among children; however, unlike in adults, no clinical trial has investigated the benefit of mechanical thrombectomy (MT) in pediatric LVO. Thus, MT remains an off-label procedure for pediatric stroke. To investigate the efficacy and safety of MT in pediatric LVO. Asystematic literature search was conducted in Ovid MEDLINE, Ovid Embase, Scopus, Web of Science, and Cochrane Central Register of Clinical Trials databases. Studies reporting safety and efficacy outcomes for endovascular treatment of pediatric LVO were included. Data regarding recanalization, functional outcome, symptomatic intracranial hemorrhage (sICH), and mortality were extracted from the included studies. Functional outcome was assessed with the modified Rankin scale (mRS). Afixed or random-effects model was used to calculate pooled event rates and 95% confidence intervals (CI). In this study 11 studies comprising 215 patients were included. The successful recanalization rate was 90.3% (95% CI = 85.77-95.11%), and complete recanalization was achieved in 52.7% (95% CI = 45.09-61.62%) of the cases. The favorable (mRS = 0-2) and excellent (mRS = 0-1) outcome rates were 83.3% (95% CI = 73.54-94.50%) and 59.5% (95% CI = 44.24-80.06%), respectively. The overall sICH prevalence was 0.59% (95% CI = 0-3.30%) and mortality rate was 3.2% (95% CI = 0.55-7.38%). In our meta-analysis, MT demonstrated apromising safety and efficacy profile for pediatric patients, with consistently high efficacy outcomes and low complication rates. Our results support the utilization of MT in pediatric LVOs; however, prospective studies are still needed to further establish the role of pediatric MT as afirst-line treatment strategy.