Creavin Samuel Thomas, Garg Megha, Hay Alastair D
Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, Bristol, UK.
ERJ Open Res. 2023 Apr 24;9(2). doi: 10.1183/23120541.00393-2022. eCollection 2023 Mar.
Our aim was to investigate the effectiveness of virtual wards on health outcomes in patients with acute respiratory infection.
We searched four electronic databases from January 2000 to March 2021 for randomised controlled trials (RCTs). We included studies in people with acute respiratory illness or an acute exacerbation of a chronic respiratory illness, where a patient or carer measured vital signs (oximetry, blood pressure, pulse) for initial diagnosis and/or asynchronous monitoring, in a person living in private housing or a care home. We performed random-effects meta-analysis for mortality.
We reviewed 5834 abstracts and 107 full texts. Nine RCTs were judged to be relevant for inclusion, in which sample sizes ranged from 37 to 389 (total n=1627) and mean ages ranged between 61 and 77 years. Five were judged to be at low risk of bias. Five RCTs had fewer hospital admissions in the intervention (monitoring) group, out of which two studies reported a significant difference. Two studies reported more admissions in the intervention group, with one reporting a significant difference. We were unable to perform a meta-analysis on healthcare utilisation and hospitalisation data due to lack of outcome definition in the primary studies and variable outcome measurements. We judged two studies to be at low risk of bias. The pooled summary risk ratio for mortality was 0.90 (95% CI 0.55-1.48).
The limited literature for remote monitoring of vital signs in acute respiratory illness provides weak evidence that these interventions have a variable impact on hospitalisations and healthcare utilisation, and may reduce mortality.
我们的目的是研究虚拟病房对急性呼吸道感染患者健康结局的有效性。
我们检索了2000年1月至2021年3月期间的四个电子数据库，以查找随机对照试验（RCT）。我们纳入了患有急性呼吸道疾病或慢性呼吸道疾病急性加重的患者的研究，这些患者或护理人员测量生命体征（血氧饱和度、血压、脉搏）用于初始诊断和/或异步监测，患者居住在私人住宅或养老院。我们对死亡率进行了随机效应荟萃分析。
我们审查了5834篇摘要和107篇全文。九项RCT被判定符合纳入标准，样本量从37至389不等（总计n = 1627），平均年龄在61至77岁之间。五项被判定为低偏倚风险。五项RCT显示干预（监测）组的住院人数较少，其中两项研究报告有显著差异。两项研究报告干预组的住院人数更多，其中一项报告有显著差异。由于原始研究中缺乏结局定义且结局测量方法各异，我们无法对医疗保健利用和住院数据进行荟萃分析。我们判定两项研究为低偏倚风险。死亡率的汇总风险比为0.90（95%CI 0.55 - 1.48）。
关于急性呼吸道疾病生命体征远程监测的文献有限，提供了薄弱的证据表明这些干预措施对住院率和医疗保健利用有不同影响，并且可能降低死亡率。
