3. Opening of the Austrian Cochrane Branch - Ruth Gilbert

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Professor Ruth Gilbert of University College London presents "Could a systematic review have prevented the epidemic of sudden infant death syndrome?" at the opening of the Austrian Cochrane Branch in Krems, Austria, on December 14th 2010.

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3. Opening of the Austrian Cochrane Branch - Ruth Gilbert

  1. 1. "Could a systematic review haveprevented the epidemic of sudden infant death syndrome?" Ruth Gilbert Centre for Evidence-based Child Health UCL Institute of Child Health, London, UK
  2. 2. 1947 – book on parent craft
  3. 3. Advice on infant sleeping position “Avoid prone (front) sleeping, particularly at night.” (review of 139 deaths) –Abramson 19441944 1950 1960 1970 1980 1990 2000 2005 Rubber sheet experiment. - “suffocation unlikely” Woolley 1945
  4. 4. Advice on infant sleeping position1944 1950 1960 1970 1980 1990 2000 2005 SIDS Infection/inhalation? Front sleeping Scoliosis, rounded heads Apnoeas, oxygenation Sleeps better
  5. 5. UK How did practice change? Netherlands Norw ay Prevalence of prone sleeping New Zealand 75 Australia Hong Kong USA 65 55 USA NTL 45% prone 35 25 15 5 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 -5 midpoint date
  6. 6. How did SIDS incidence change?Arch Dis Child1995;72:478-82.
  7. 7. Clinical studies timeline Comparative clinical studies Case control/cohort1944 1950 1960 1970 1980 1990 2000 2005 ??? ?
  8. 8. Front vs back
  9. 9. Front vs other positions
  10. 10. Can we infer causality?• RCTs feasible in 1970 but not after• Evidence only from systematic review of observational studies• But…. – Strong association – Not explained by confounders – Dose effect (side, front vs back) – SIDS reduced when front sleeping declined
  11. 11. Change in SIDS incidence as front sleeping declined Postneonatal SIDS: England & Wales 2.5 deaths/1000 live births 2 1.5 1 0.5 Avon campaign National campaign 0 74 76 78 80 82 84 86 88 90 92 94 96 98 19 19 19 19 19 19 19 19 19 19 19 19 19 yearSource: Office of National Statistics
  12. 12. SIDS incidence: Europe 1987-1997Change in 5 Austria E&W NTL Norway Scotland SwitzSIDS 4 rate/1000 3 incidence 2 1 0 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 SIDS incidence 1987-1997Excess death toll Australia NZ USAdue to prone 5sleeping in 20y 4 rate/1000 3USA>40,000 2UK >10,000 1 0 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
  13. 13. Lessons1) Clinical practice requires clinical evidence2) Delays in systematically reviewing evidence can cost lives3) Systematic reviews – can help to explain conflicting results
  14. 14. "Could a systematic review haveprevented the epidemic of sudden infant death syndrome?" Possibly!
  15. 15. Why did it take so long to change advice? De Jonge (NTL)1944 1950 1960 1970 1980 1990 2000 2005 SIDS foundation (UK) Government advice USA
  16. 16. Acknowledgements• Georgia Salanti, Sarah See, Melissa Harden (co-authors), Chris Hiley, Iain ChalmersGilbert, Salanti, Harden, See. Int J Epid 2005r.gilbert@ich.ucl.ac.uk

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