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. "Could a systematic review have prevented the epidemic of sudden infant death syndrome?" Ruth Gilbert Centre for Evidence-based Child Health UCL Institute of Child Health, London, UK
- 2. 1947 – book on parent craft
- 3. Advice on infant sleeping position “Avoid prone (front) sleeping, particularly at night.” (review of 139 deaths) –Abramson 1944 1944 1950 1960 1970 1980 1990 2000 2005 Rubber sheet experiment. - “suffocation unlikely” Woolley 1945
- 4. Advice on infant sleeping position 1944 1950 1960 1970 1980 1990 2000 2005 SIDS Infection/inhalation? Front sleeping Scoliosis, rounded heads Apnoeas, oxygenation Sleeps better
- 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. How did SIDS incidence change? Arch Dis Child 1995;72:478-82.
- 7. Clinical studies timeline Comparative clinical studies Case control/cohort 1944 1950 1960 1970 1980 1990 2000 2005 ??? ?
- 9. Front vs other positions
- 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. 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 year Source: Office of National Statistics
- 12. SIDS incidence: Europe 1987-1997 Change in 5 Austria E&W NTL Norway Scotland Switz SIDS 4 rate/1000 3 incidence 2 1 0 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 SIDS incidence 1987-1997 Excess death toll Australia NZ USA due to prone 5 sleeping in 20y 4 rate/1000 3 USA>40,000 2 UK >10,000 1 0 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997
- 13. Lessons 1) Clinical practice requires clinical evidence 2) Delays in systematically reviewing evidence can cost lives 3) Systematic reviews – can help to explain conflicting results
- 14. "Could a systematic review have prevented the epidemic of sudden infant death syndrome?" Possibly!
- 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. Acknowledgements • Georgia Salanti, Sarah See, Melissa Harden (co-authors), Chris Hiley, Iain Chalmers Gilbert, Salanti, Harden, See. Int J Epid 2005 r.gilbert@ich.ucl.ac.uk