Figure 4 . Disposition of Documents Identified by Internal Searches and Outside Submissions (Text description)

Figure 4 is an attrition diagram that includes a diagram of documents identified by internal literature searches alongside a diagram of documents submitted by interested parties for possible inclusion in the report.

On the left side is an attrition diagram of documents identified by internal literature searches. The diagram begins with a box outlining the 1078 documents identified. Several boxes ensue which are connected by arrows going from top to bottom which follow the documents as they are being screened for possible inclusion in the report.

In the first frame we remove documents at the abstract level that are not relevant to the report. 790 documents were excluded.

The path then follows the 288 documents retrieved. During this phase of screening we do a more extensive screening of the articles based on our pre-determined inclusion/exclusion criteria.

151 articles were excluded during this evaluation phase leaving 137 articles that met our inclusion criteria. Of these 137 articles, 37 addressed Key Question 1; zero were relevant to Key Question 2; 79 studies addressed Key Question 3; zero studies addressed Key Question 4; and 21 studies were included as Systematic Reviews of NPWT.

On the right side is a separate attrition diagram that depicts the status of documents that interested stakeholders submitted for possible inclusion in the report.

The diagram begins with a box outlining the total submission of 1435 documents. Several boxes ensue which are connected by arrows going from top to bottom which follow the submissions as they are being screened for possible inclusion in the report.

In the first frame, we remove duplicate submissions made by all interested stakeholders. 638 duplicate submissions were identified.

An arrow leads from the 797 unique submissions to the initial screening phase where documents may be excluded, used in our Background Section or passed to the next level. In this instance, 269 documents were identified for exclusion. 147 were case reports, abstracts, or poster presentations; two were product information; 28 were personal communications; and 92 were other documents not relevant to the report.

29 documents were identified for inclusion in our Background Section and included 510(k) clearance information from the FDA and information from product labels and brochures.

The path then follows the 499 full articles remaining. During this phase of screening we do a more extensive screening of the full articles which is again based on our pre-determined inclusion/exclusion criteria.

354 full articles were excluded during this evaluation phase. 39 were animal studies; four were cost analyses; ten were duplicate studies; 30 included fewer than 5 patients; 13 were guidelines; five were homemade devices; four were in vitro studies; 152 were narrative reviews; ten did not include relevant outcomes; five were not clinical studies; 11 did not include a NPWT device; 28 were not a NPWT study and 43 were excluded for other reasons which may include "inclusion of healthy subjects", "lack of reporting wound healing outcomes" or "patients treated with dual therapies."

Of the 144 full articles remaining for possible inclusion in the report; 117 articles were already identified in our literature searches. Of the 27 articles that ultimately met the inclusion criteria but were not identified in the literature searches; three studies addressed Key Question 1, 23 studies were relevant to Key Question 3 and one was identified as a systematic review. In addition, we included one unpublished study in Key Question 3 due to relevancy of the article bringing a total of 24 studies that addressed Key Question 3.

The two diagrams are joined at the bottom to summarize the total studies assessed in the report. Of the 165 studies included in the report, 40 studies addressed Key Question 1; zero studies addressed Key Question 2; 103 studies addressed Key Question 3; zero studies addressed Key Question 4; and 22 were identified as Systematic Reviews of NPWT. Note: Language has been corrected to reflect screening of meeting abstracts, poster presentations and other documents in addition to abstracts of full articles.

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