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Incidence of admission ionised hypocalcaemia in paediatric major trauma: protocol for a systematic review and meta-analysis

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Harris, Tim 
Barnard, Ed Benjamin Graham  ORCID logo


Introduction: Hypocalcaemia forms part of the ‘diamond of death’ in major trauma, alongside hypothermia, acidosis and coagulopathy. In adults, admission hypocalcaemia prior to transfusion is associated with increased mortality, increased blood transfusion requirements and coagulopathy. Data on paediatric major trauma patients are limited. This systematic review and meta-analysis aims to describe and synthesise the available evidence relevant to paediatric trauma, admission hypocalcaemia and outcome. Methods and analysis: The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines will be used to construct this review. A planned literature search for articles in the English language will be conducted from inception to the date of searches using MEDLINE on the EBSCO platform, CINAHL on the EBSCO platform and Embase on the Ovid platform. The grey literature will also be searched. Both title and abstract screening and full-text screening will be done by two reviewers, with an adjudicating third reviewer. Heterogeneity will be assessed using the I2 test, and the risk of bias will be assessed using the ROBINS-I tool. A meta-analysis will be undertaken using ratio measures (OR) and mean differences for measures of effect. When possible, the estimate of effect will be presented along with a CI and a p value. Ethical review and dissemination: Ethical review is not required, as no original data will be collected. Results will be disseminated through peer-reviewed publications and at academic conferences. PROSPERO registration number: CRD42023425172.


Peer reviewed: True

Acknowledgements: The authors would like to acknowledge and thank Catherine Hancox and the Defence Medical Academic Library Team for their assistance with the search strategy.


paediatric orthopaedic & trauma surgery, calcium & bone, paediatric intensive & critical care, accident & emergency medicine, paediatric A&E and ambulatory care

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BMJ Open

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BMJ Publishing Group