Winters Bradford D, Pham Julius Cuong, Hunt Elizabeth A, Guallar Eliseo, Berenholtz Sean, Pronovost Peter J
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, MD, USA.
Crit Care Med. 2007 May;35(5):1238-43. doi: 10.1097/01.CCM.0000262388.85669.68.
Rapid response systems have been advocated as a potential model to identify and intervene in patients who are experiencing deterioration on general hospital wards.
To conduct a meta-analysis to evaluate the impact of rapid response systems on hospital mortality and cardiac arrest rates.
We searched MEDLINE, EMBASE, and the Cochrane Library from January 1, 1990, to June 30, 2005, for all studies relevant to rapid response systems. We restricted the search to the English language and by age category (all adults: >or=19 years).
We selected observational and randomized trials of rapid response systems that provided empirical data on hospital mortality and cardiac arrest in control and intervention groups. We reviewed 10,228 abstracts and identified eight relevant studies meeting these criteria.
Of the included studies, five used historical controls, one used concurrent controls, and two used a cluster-randomized design. The pooled relative risk for hospital mortality comparing rapid response teams to control was 0.76 (95% confidence interval, 0.39-1.48) between the two randomized studies and 0.87 (95% confidence interval, 0.73-1.04) among the five observational studies. The pooled relative risk for cardiac arrest comparing rapid response systems to control was 0.94 (95% confidence interval, 0.79-1.13) in the single randomized study and 0.70 (95% confidence interval, 0.56-0.92) in four observational studies.
We found weak evidence that rapid response systems are associated with a reduction in hospital mortality and cardiac arrest rates, but limitations in the quality of the original studies, the wide confidence intervals, and the presence of heterogeneity limited our ability to conclude that rapid response systems are effective interventions. Large randomized controlled trials are needed to clarify the efficacy of rapid response systems before they should become standard of care.
快速反应系统已被倡导作为一种潜在模式，用于识别和干预综合医院病房中病情恶化的患者。
进行一项荟萃分析，以评估快速反应系统对医院死亡率和心脏骤停发生率的影响。
我们检索了1990年1月1日至2005年6月30日期间的MEDLINE、EMBASE和Cochrane图书馆，查找所有与快速反应系统相关的研究。我们将检索范围限制在英文文献，并按年龄类别（所有成年人：≥19岁）进行筛选。
我们选择了关于快速反应系统的观察性和随机试验，这些试验提供了对照组和干预组医院死亡率及心脏骤停的实证数据。我们审查了10228篇摘要，确定了八项符合这些标准的相关研究。
纳入的研究中，五项使用历史对照，一项使用同期对照，两项使用整群随机设计。两项随机研究中，将快速反应团队与对照组相比，医院死亡率的合并相对风险为0.76（95%置信区间，0.39 - 1.48）；五项观察性研究中，该合并相对风险为0.87（95%置信区间，0.73 - 1.04）。单项随机研究中，将快速反应系统与对照组相比，心脏骤停的合并相对风险为0.94（95%置信区间，0.79 - 1.13）；四项观察性研究中，该合并相对风险为0.70（95%置信区间，0.56 - 0.92）。
我们发现有微弱证据表明快速反应系统与医院死亡率和心脏骤停发生率的降低有关，但原始研究质量的局限性、宽泛的置信区间以及异质性的存在限制了我们得出快速反应系统是有效干预措施的结论。在快速反应系统成为标准治疗方法之前，需要进行大型随机对照试验来阐明其疗效。
