Home > DARE Reviews > A systematic review of controlled...

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

A systematic review of controlled studies: do physicians increase survival with prehospital treatment?

MT Botker, SA Bakke, and EF Christensen.

Review published: 2009.

CRD summary

This review concluded that the limited evidence identified revealed an increased survival with physician treatment in patients with trauma and cardiac arrest. Indications of increased survival were found in respiratory diseases and acute myocardial infarction. A degree of caution might be required in interpreting these conclusions given the possibility of publication bias and low methodological rigour of included studies.

Authors' objectives

To assess whether physicians increase patient survival in prehospital treatment compared with paramedical personnel.

Searching

PubMed, EMBASE and The Cochrane Library were searched from January 1990 to November 2008 without language restrictions. Search terms were reported. The PubMed related articles feature was searched to identify additional studies. Reference lists of relevant studies were screened.

Study selection

Controlled studies that compared treatment by prehospital physicians with treatment by paramedical personnel in patients with trauma or any acute illness were eligible for inclusion. Treatment by physicians had to be an additional therapeutic intervention. Eligible outcome measures were survival, mortality and derivates.

Most of the included studies recruited trauma patients. Some studies recruited patients with out of hospital cardiac arrest. Only two studies included broader unselected patient groups (all patients retrieved with helicopter and attended by an ambulance).

Two reviewers independently assessed studies for inclusion. Any disagreements were resolved by consensus with a third reviewer.

Assessment of study quality

No formal validity assessment was performed. Studies were classified into three categories by type of study design: controlled cohort studies, before-and-after studies and system comparison studies (comparison of outcome in two geographically separate areas).

Data extraction

Data were extracted on event rates to enable calculation of odds ratios (ORs) with 95% confidence intervals (CIs).

Two reviewers independently performed data extraction. Any disagreements were resolved by consensus with a third reviewer.

Methods of synthesis

The studies were combined in a narrative synthesis supported by data tables. Subgroup analyses were performed on different types of patients (trauma, out of hospital cardiac arrest and unselected/broader patient groups).

Results of the review

Twenty-six studies were included in the review: 16 controlled cohort studies, five system comparison studies and five before-and-after studies. Twelve studies followed patients until hospital or discharge from the intensive care unit. Reported follow-up for the other studies ranged from one month to three years.

Fourteen studies showed that compared with treatment by paramedical personnel, there was a significantly higher survival rate in the group with treatment by physicians. However, three studies showed a significantly lower rate in survival in the group with treatment by physicians. Nine studies did not demonstrate a significant difference in survival rate between the two groups.

In the 19 studies of trauma patients (number of patients in the intervention group ranged from 25 to 14,702), nine studies reported that physician treatment significantly increased survival compared with paramedical treatment.

In the five studies of patients with out of hospital cardiac arrest (number of patients in the intervention group ranging from nine to <100), four studies reported that physician treatment significantly increased survival compared with paramedical treatment.

The two studies of unselected/broader patient groups (number of patients in the intervention group ranging from 211 to 2,869) showed no significant difference in survival between physician and paramedical treatment groups. However, one study reported a significant increase in survival rate with physician treatment in a subgroup of patients with acute myocardial infarction and respiratory diseases.

Authors' conclusions

The limited evidence identified revealed an increased survival with physician treatment in patients with trauma and cardiac arrest. Indications of increased survival were found in respiratory diseases and acute myocardial infarction. Many

conditions seen in the prehospital setting remain unexamined.

CRD commentary

This review's inclusion criteria were clear. Relevant databases were searched. Efforts were made to find published studies. Unpublished studies were not sought, which increased potential for publication bias. No language restrictions were applied to the search, which reduced the risk of language bias. Steps were made to minimise errors and biases in the processes of study selection and data extraction. No formal validity assessment was performed, but the authors discussed some aspects such as the potential influence of confounding factors. The included studies were observational studies and, therefore, were of low methodological rigour. Given the diversity of included studies, a narrative synthesis was appropriate.

The authors' conclusions reflected the evidence presented. However, a degree of caution might be required in interpreting these conclusions given the possibility of publication bias and low methodological rigour of included studies.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that future research should investigate the impact of physician treatment on patient survival outcome in other conditions in the prehospital setting (beyond the conditions of trauma and out of hospital cardiac arrest) and whether treatment by physicians can avoid unnecessary hospital admission.

Funding

Not stated.

Bibliographic details

Botker MT, Bakke SA, Christensen EF. A systematic review of controlled studies: do physicians increase survival with prehospital treatment? Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2009; 17(1):12. [PMC free article: PMC2657098] [PubMed: 19265550]

Indexing Status

Subject indexing assigned by NLM

MeSH

Emergency Medical Services /manpower; Humans; Physician's Role; Survival

AccessionNumber

12010006211

Database entry date

07/09/2011

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 19265550

Download

PubMed Health Blog...

read all...

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...