Efficacy of Increased Salt and Water Intake on Pediatric Vasovagal Syncope: A Meta-Analysis Based on Global Published Data

Figures

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  Figure 1. Study screening diagram. In the process of screening and selection, a total of 867 studies were obtained. Finally, five studies were included. CNKI, China National Knowledge Infrastructure; RCT, randomized controlled trial.

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  Figure 2. Quality evaluation of the studies. (A) Summary of bias risk in each study. Evaluation of the bias risk was based on the reviewers' assessments of seven items for each selected study as follows. “+” implies the existence of a low risk, “-” implies the existence of a high risk, “?” implies unclear risk bias because of a lack of relevant information. (B) Summary of bias risk in each item. Evaluation of the bias risk for each item was based on reviewers' assessments of five studies for each bias risk item and are presented as percentages.

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  Figure 3. Funnel plot of the studies. (A) Funnel plot of studies using the negative changing rate of the HUTT as the efficacy evaluation. (B) Funnel plot of studies taking syncope or presyncope recurrence rate as the efficacy evaluation. Each dot on the funnel plot represents a study, the horizontal axis represents the effect size, and the vertical axis represents the standard error. As shown in the plot, each study was close to the ideal effect value on the horizontal axis as they were evenly distributed on both sides, and each study had a low standard error on the vertical axis. SE, standard error; RR, relative risk.

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  Figure 4. Forest plot of the studies. (A) Forest plot of the studies evaluating therapeutic efficacy of increased salt and water intake with the negative changing rate of HUTT. (B) Forest plot of the studies evaluating the therapeutic efficacy of increased salt and water intake with syncope or presyncope recurrence rate. Heterogeneity analysis showed no conspicuous heterogeneity among the above studies, and a fixed-effect model was adopted. The RR results analyzed by the M-H test are summarized on the right. The RR and its 95% CI of each study are represented by small squares and transverse lines, respectively, and the rhombus below represents the overall results of the meta-analysis. RR, risk ratio; CI, confidence interval; M-H, Mantel-Haenszel test.

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  Figure 5. Forest plot of the subgroup analysis. (A) Forest plot of the studies evaluating the therapeutic efficacy of different subgroup with the negative changing rate of HUTT. (B) Forest plot of the studies evaluating the therapeutic efficacy of different subgroup with the syncope or presyncope recurrence rate. Heterogeneity analysis showed no conspicuous heterogeneity among the above studies, and a fixed-effect model was adopted. The RR results analyzed by the M-H test are summarized on the right. The RR and its 95% CI of each study are represented by small squares and transverse lines, respectively, and the rhombus below represents the overall results of the meta-analysis. RR, risk ratio; CI, confidence interval; M-H, Mantel-Haenszel test.