Validity assessment of included studies using the Newcastle–Ottawa Scale (11)
| Study | Design | Setting; representiveness | Patients selected using a priori criteria | Level of training and supervision in the technique | Adverse effects and outcomes sought and documented systematically |
|---|---|---|---|---|---|
| Botma et al. 2000 (1) | Prospective/consecutive | Hospital emergency department; truly representative | Yes | Procedure explained to parents, performed under supervision of attending doctor | Yes |
| Purohit et al. 2008 (12) | Prospective/consecutive | Hospital emergency and ear, nose and throat departments; truly representative | Yes | Procedure clearly explained to parent | No, but stated that there were no complications |
| Backlin 1995 (13) | Retrospective | Hospital emergency department; somewhat representative | No | Instructions given to caregiver | Not specified, but none documented |
| Wagner 2003 (14) | Retrospective | Hospital emergency department, referred to otologist; somewhat representative | No | Parents instructed in the technique | No, but none documented |
| Taylor et al. 2010 (15) | Retrospective | Hospital pediatric emergency department; somewhat representative | No | Trained triage nurse on duty explained manoeuvre to parents | Yes, but none documented |
| Alleemudder et al. 2007 (16) | Not specified | Hospital emergency department; somewhat representative | No | Clear explanation given to parent, assistant held child | Not specified, but none documented |
| Hore 1996 (17) | Case report | Home; selected patient | No | Father was doctor and followed Backlin’s description (13) | No, but none documented |
| Manca 1997 (18) | Case report | Home; selected patient | No | Mother was doctor experienced in technique | No, but none documented |
Note: Items from the Newcastle–Ottawa scale not shown here include determining exposure (secure written records for all studies), length of follow-up sufficient for outcomes to occur (sufficient in all studies), assessment of outcome (unblinded, but objective for all studies) and adequacy of follow-up (complete for all studies).