对急诊室昏迷患者的风险分层工具:对SAEM GRACE的直接证据进行系统审查和元分析
Abel Wakai1,2, Richard Sinert3,4, Shahriar Zehtabchi3,4
1Department of Emergency Medicine, Beaumont Hospital, Dublin, Ireland.
概括
临床决策规则 (CDR) 对于急诊室 (ED) 昏迷管理往往缺乏高质量的证据. 虽然一些规则,如旧金山综合规则显示承诺,大多数需要进一步验证可靠的临床使用.
科学领域:
- 紧急医疗 紧急医疗
- 心脏病学 心脏病学
- 临床流行病学临床流行病学
背景情况:
- 昏迷影响10%的患者,严重的潜在原因在ED中并不总是被确定.
- 临床决策规则 (CDR) 旨在对ED昏迷患者的不良后果进行风险分层.
- 制定基于证据的管理准则需要评估CDR的质量和准确性.
研究的目的:
- 系统地审查和元分析关于ED综合症CDR的方法质量和预测准确性的证据.
- 为制定基于证据的ED综合症管理指南提供信息.
主要方法:
- 使用患者干预控制结果 (PICO) 问题进行系统的文献搜索.
- 纳入标准:年龄≥16岁的患者出现ED并昏迷,风险分层工具与常规护理相比,30天的结果.
- 文章的独立审稿人评估,方法质量和使用Meta-DiSc.Sc.的统计分析.
主要成果:
- 31项研究 (13项CDR) 满足了来自2047个出版物的纳入标准.
- 13个衍生研究 (17,578名参与者) 和24个验证研究 (14,845名参与者).
- 旧金山同步规则 (SFSR),加拿大同步风险评分 (CSRS) 和OESIL风险评分在多项研究中得到了验证,显示了重叠的操作特征.
结论:
- 大多数用于ED综合症管理的CDR对常规临床实践具有低质量的证据.
- 只有SFSR,CSRS和OESIL在两个以上的研究中得到了验证.
- 需要进一步的高质量验证来支持这些CDR的常规临床使用.
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