即时检测床边检测工具在门诊护理中的影响：系统评价和荟萃分析。
Impact of point-of-care panel tests in ambulatory care: a systematic review and meta-analysis.
机构信息
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, UK
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, UK.
出版信息
BMJ Open. 2020 Feb 27;10(2):e032132. doi: 10.1136/bmjopen-2019-032132.
OBJECTIVES
This article summarises all the available evidence on the impact of introducing blood-based point-of-care panel testing (POCT) in ambulatory care on patient outcomes and healthcare processes.
DESIGN
Systematic review and meta-analysis of randomised-controlled trials and before-after studies.
DATA SOURCES
Ovid Medline, Embase, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, Database of Abstracts of Reviews and Effects, Science Citation Index from inception to 22 October 2019.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Included studies were based in ambulatory care and compared POCT with laboratory testing. The primary outcome was the time to decision regarding disposition that is, admission/referral termed disposition decision (DD) time. Secondary outcomes included length of stay (LOS) at the ambulatory care unit/practice and mortality.
RESULTS
19 562 patients from nine studies were included in the review, eight of these were randomised-controlled trials, and one was a before-after study. All the studies were based in either emergency departments or the ambulance service; no studies were from primary care settings. General panel tests performed at the POCT resulted in DDs being made 40 min faster (95% CI -42.2 to -36.6, I=0%) compared with the group receiving usual care, including central laboratory testing. This in turn resulted in a reduction in LOS for patients who were subsequently discharged by 34 min (95% CI -63.7 to -5.16). No significant difference in mortality was reported.
DISCUSSION
Although statistical and clinical heterogeneity is evident and only a small number of studies were included in the meta-analysis, our results suggest that POCTs might lead to faster discharge decisions. Future research should be performed in primary care and identify how POCTs can contribute meaningful changes to patient care rather than focusing on healthcare processes.
PROSPERO REGISTRATION NUMBER
CRD42016035426.
目的
本文总结了在门诊护理中引入基于血液的即时检测（POCT）对患者结局和医疗流程的所有可用证据。
设计
随机对照试验和前后对照研究的系统评价和荟萃分析。
数据来源
Ovid Medline、Embase、Cochrane 系统评价数据库、Cochrane 中心、综述摘要数据库和效果数据库、科学引文索引，从创建到 2019 年 10 月 22 日。
纳入研究标准
纳入的研究基于门诊护理，并将 POCT 与实验室检测进行比较。主要结局是关于处置的决策时间，即入院/转介称为处置决策（DD）时间。次要结局包括门诊护理单位/实践中的住院时间（LOS）和死亡率。
结果
共有 9 项研究的 19562 名患者纳入综述，其中 8 项为随机对照试验，1 项为前后对照研究。所有研究均基于急诊科或救护车服务；没有来自初级保健机构的研究。在 POCT 进行的一般面板检测使 DD 提前 40 分钟（95%CI-42.2 至-36.6，I=0%），与接受常规护理的组相比，包括中心实验室检测。这反过来又使随后出院的患者 LOS 减少了 34 分钟（95%CI-63.7 至-5.16）。未报告死亡率的显著差异。
讨论
尽管存在明显的统计学和临床异质性，并且只有少数研究纳入荟萃分析，但我们的结果表明，POCT 可能导致更快的出院决策。未来的研究应在初级保健中进行，并确定 POCT 如何为患者护理带来有意义的改变，而不仅仅是关注医疗流程。
PROSPERO 注册号：CRD42016035426。
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