DEFACTUM,Department of Public Health and Health Services Research.
Int J Technol Assess Health Care. 2019 Jan;35(1):27-35. doi: 10.1017/S0266462318003616. Epub 2019 Feb 6.
The aim of this overview was to systematically identify and synthesize existing evidence from systematic reviews on the impact of prehospital physician involvement.
The Medline, Embase, and Cochrane library were searched from 1 January 2000 to 17 November 2017. We included systematic reviews comparing physician-based with non-physician-based prehospital treatment in patients with one of five critical conditions requiring a rapid response.
Ten reviews published from 2009 to 2017 were included. Physician treatment was associated with increased survival in patients with out-of-hospital cardiac arrest and patients with severe trauma; in the latter group, the result was based on more limited evidence. The success rate of prehospital endotracheal intubation (ETI) has improved over the years, but ETI by physicians is still associated with higher success rates than intubation by paramedics. In patients with severe traumatic brain injury, intubation by paramedics who were not well skilled to do so markedly increased mortality.
Current evidence is hinting at a benefit of physicians in selected aspects of prehospital emergency services, including treatment of patients with out-of-hospital cardiac arrest and critically ill or injured patients in need of prehospital intubation. Evidence is, however, limited by confounding and bias, and comparison is hampered by differences in case mix and the organization of emergency medical services. Future research should strive to design studies that enable appropriate control of baseline confounding and obtain follow-up data for the proportion of patients who die in the prehospital setting.
本综述旨在系统地识别和综合现有系统评价中关于院前医生参与的影响的证据。
从 2000 年 1 月 1 日至 2017 年 11 月 17 日，检索了 Medline、Embase 和 Cochrane 图书馆。我们纳入了比较基于医生和非医生的院前治疗对五种需要快速反应的危急情况患者的系统评价。
纳入了 2009 年至 2017 年发表的 10 篇综述。在院外心脏骤停和严重创伤患者中，医生治疗与生存率的提高相关；在后一组中，结果基于更有限的证据。多年来，院前气管插管（ETI）的成功率有所提高，但医生进行 ETI 的成功率仍高于护理人员。在严重创伤性脑损伤患者中，技能不熟练的护理人员进行插管明显增加了死亡率。
目前的证据暗示医生在院前急救服务的某些方面有益，包括治疗院外心脏骤停患者和需要院前插管的危重病或受伤患者。然而，证据受到混杂和偏倚的限制，并且由于病例组合和急诊医疗服务组织的差异，比较受到阻碍。未来的研究应努力设计能够适当控制基线混杂并获得在院前环境中死亡的患者比例的随访数据的研究。
