Alfred Hospital, Melbourne, Victoria, Australia.
Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia.
Emerg Med Australas. 2019 Jun;31(3):321-331. doi: 10.1111/1742-6723.13288. Epub 2019 Apr 3.
The aim of this systematic review and meta-analysis was to evaluate the outcomes of patients who are not transported to hospital following ambulance attendance. A database search was conducted using PubMed, Medline, Embase, CINAHL and Cochrane Library. Studies were included if they analysed the outcomes of patients who were not transported following ambulance attendance. The primary outcome of this review was subsequent presentation to an ED following a non-transport decision. Secondary outcome measures included hospital admission, subsequent presentation to alternative service provider (e.g. private physician), and death at follow up. The search yielded 1953 non-duplicate articles, of which 10 met the inclusion criteria. Three studies specified that the non-transport decision was emergency medical services (EMS)-initiated, seven studies did not specify. Meta-analysis found substantial heterogeneity between estimates (I >50%) that was likely because of differences in study design, length of follow up, patient demographic and sample size. Between 5% and 46% (pooled estimate 21%; 95% CI 11-31%) of non-transport patients subsequently presented to ED. Few (pooled estimate 8%; 95% CI 5-12%) EMS-initiated non-transport patients were admitted to hospital compared to the unspecified group (pooled estimate 40%; 95% CI 7-72%). Mortality rates were low across included studies. Studies found varying estimates for the proportion of patients discharged at the scene that subsequently presented to ED. Few patients were admitted to hospital when the non-transport decision was initiated by EMS, indicating EMS triage is a relatively safe practice. More research is needed to elucidate the context of non-transport decisions and improve access to alternative pathways.
本系统评价和荟萃分析的目的是评估救护车出勤后未送往医院的患者的结局。使用 PubMed、Medline、Embase、CINAHL 和 Cochrane Library 进行了数据库检索。如果分析了救护车出勤后未转运患者的结局，则纳入研究。本综述的主要结局是在非转运决策后随后到急诊科就诊。次要结局指标包括住院、随后到替代服务提供者（如私人医生）就诊以及随访时死亡。搜索产生了 1953 篇非重复文章，其中 10 篇符合纳入标准。有 3 项研究具体说明非转运决定是由紧急医疗服务（EMS）发起的，7 项研究未具体说明。荟萃分析发现估计值之间存在很大的异质性（I >50%），这可能是由于研究设计、随访时间、患者人口统计学和样本量的差异所致。在非转运患者中，有 5%至 46%（汇总估计值 21%；95%CI 11-31%）随后到急诊科就诊。与未指定组（汇总估计值 40%；95%CI 7-72%）相比，EMS 发起的非转运患者中很少有（汇总估计值 8%；95%CI 5-12%）住院。纳入研究的死亡率均较低。研究发现，在随后到急诊科就诊的在现场被放行的患者比例方面存在不同的估计值。当非转运决定由 EMS 发起时，很少有患者被收治入院，这表明 EMS 分诊是一种相对安全的做法。需要进一步研究阐明非转运决定的背景，并改善获得替代途径的机会。
