SUPPLEMENTAL MATERIAL A comparison of video-assisted thoracoscopic surgery with open thoracotomy for the management of chest trauma: a systematic review and meta-analysis Na Wu1, 2 *, Long Wu1, 2 * Chongying Qiu1, 2, Zubin Yu3, Ying Xiang1, 2, Minghao Wang 4, Jun Jiang 4 #, Yafei Li1, 2 # 1 Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, People’s Republic of China 2 Center for Clinical Epidemiology and Evidence-based Medicine, Third Military Medical University, Chongqing, People’s Republic of China 3 Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, People’s Republic of China 4 Breast Disease Center, Southwest Hospital, Third Military Medical University, Chongqing 400038, People’s Republic of China * These authors contributed equally to this work. # These authors jointly directed the project. Correspondence: Yafei Li Ph.D. Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, People’s Republic of China E-mail: liyafei2008@hotmail.com Telephone: +86 23 68752293 Supplementary Table 1. Newcastle-Ottawa Quality assessment score scale Item Score NOS score scale for cohort studies† Selection (1) Representativeness of the exposed cohort Truly representative of the average status in the community 1 Somewhat representative of the average status in the community 1 Selected group of users eg nurses, volunteers 0 No description of the derivation of the cohort 0 (2) Selection of the non exposed cohort Drawn from the same community as the exposed cohort 1 Item Score Drawn from a different source 0 No description of the derivation of the non exposed cohort 0 (3) Ascertainment of exposure Secure record (eg surgical records) 1 Structured interview 1 Written self report 0 No description 0 (4) Demonstration that outcome of interest was not present at start of study Yes 1 No 0 Comparability (1) Comparability of cohorts on the basis of the design or analysis Study controls for the most important factor 1 Study controls for any additional factor 1 Outcome (1) Assessment of outcome Independent blind assessment 1 Record linkage 1 Self report 0 No description 0 (2) Was follow-up long enough for outcomes to occur? Yes 1 No 0 (3) Adequacy of follow up of cohorts † Complete follow up - all subjects accounted for 1 Subjects lost to follow up unlikely to introduce bias 1 Follow up rate is low and no description of those lost 0 No statement 0 A study can be awarded a maximum of one score for each numbered item within the Selection and Outcome categories. A maximum of two scores can be given for Comparability. Supplementary Table 2. Newcastle-Ottawa Scale score of included cohort studies Selection First author Comparability Outcome Representativeness of Selection of the non Ascertainment of Demonstration that Comparability of Assessment of Was follow-up long Adequacy of follow Total the exposed cohort exposed cohort exposure outcome of interest cohorts on the basis outcome enough for outcomes up of cohorts score was not present at of the design or start of study analysis to occur Lian A 0 1 1 1 0 1 1 1 6 Ben-Nun A 0 1 1 1 2 1 1 1 8 Lu H 0 1 1 1 2 1 1 1 8 Yu H 0 1 1 1 2 1 1 1 8 Yuan K 0 1 1 1 2 1 1 1 8 Yang L 0 1 1 1 2 1 1 1 8 Huang S 0 1 1 1 2 1 1 1 8 Lu T 0 1 1 1 2 1 1 1 8 Liu W 0 1 1 1 2 1 1 1 8 Yu X 0 1 1 1 2 1 1 1 8 Xie X 0 1 1 1 1 1 1 1 7 Li Y 0 1 1 1 2 1 1 1 8 Wang Y 0 1 1 1 2 1 1 1 8 Samiatina D 0 1 1 1 1 1 1 1 7 Supplementary Table 3. Cochrane Collaboration’s risk of bias assessment results of included RCTs First author Random sequence Allocation concealment generation Blinding of participants Blinding of outcome and personnel assessment Incomplete outcome data Selective reporting Other bias Long C Unclear Unclear Low risk Low risk Low risk Low risk Low risk Li F Unclear Unclear Low risk Low risk High risk Low risk Low risk Liao F Unclear Unclear Low risk Low risk Low risk Low risk Low risk Li G Unclear Unclear Low risk Low risk Low risk Low risk Low risk Chen J Unclear Unclear Low risk Low risk Low risk Low risk Low risk Jiang J High risk Unclear Low risk Low risk Low risk Low risk Low risk Hao Q Unclear Unclear Low risk Low risk Low risk Low risk Low risk Zhao Q Unclear Unclear Low risk Low risk Low risk Low risk Low risk Hu W Unclear Unclear Low risk Low risk Low risk Low risk Low risk Li X Unclear Unclear Low risk Low risk Low risk Low risk Low risk Cao Y Low risk Unclear Low risk Low risk Low risk Low risk Low risk Peng Y Unclear Unclear Low risk Low risk Low risk Low risk Low risk Articles identified through database searching (n=2131) (390 English, 1639 Chinese and 102 in other languages) Articles excluded based on titles and abstracts (n=1540) Articles (275 English, 1169 Chinese and 96 in other languages) references (n=1) retrieved by Complete article analyzed (n=592) (116 English, 470 Chinese and 6 in other languages) 566 articles without proper comparison, duplicate publication or laparoscopy excluded 26 articles included in meta-analysis Supplementary Figure 1. Flow-chart of the searching process cross-