终止复苏(TOR)规则可能有助于指导院前决定停止复苏,对患者预后和卫生资源使用有潜在影响。具有高灵敏度风险的规则增加了非幸存者的不当运输,而没有优异特异性的规则有错过幸存者的风险。需要进一步检查TOR规则在估计院外心脏骤停(OHCA)生存率方面的性能。
■确定TOR规则是否可以准确识别无法在OHCA中幸存的患者。
■对于本系统综述和荟萃分析,MEDLINE,Embase,CINAHL,科克伦图书馆,从数据库开始到2024年1月11日,搜索了WebofScience数据库。语言没有限制,出版日期,或研究的时间范围。
■两位评审员独立筛选记录,首先是标题和摘要,然后是全文。随机临床试验,病例对照研究,队列研究,横断面研究,回顾性分析,并包括建模研究。回顾了系统评价和荟萃分析,以确定主要研究。预测死亡以外结果的研究,住院研究,动物研究,非同行评审的研究被排除.
■数据由一名审阅者提取,并由一秒钟检查。两名评审员使用修订后的诊断准确性研究质量评估工具评估偏倚风险。Cochrane筛查和诊断测试方法在进行双变量随机效应荟萃分析时,遵循小组建议。本综述遵循了诊断测试准确性研究系统评价和荟萃分析(PRISMA-DTA)声明的首选报告项目,并在国际前瞻性系统评价登记册(CRD42019131010)注册。
■产生了具有95%CIs的敏感性和特异性表以及双变量汇总接受者工作特征(SROC)曲线。计算了不同患病率水平下的影响估计。这些估计用于评估不同患病率水平下使用TOR规则的实际含义。
■本综述包括1993年至2023年间发表的43项非随机研究,涉及29项TOR规则,涉及1125587例病例。15项研究报告了20项TOR规则的推导。33项研究报告了17项TOR规则的外部数据验证。七个TOR规则有数据来促进荟萃分析。确定了一项临床研究。复苏规则的普遍终止具有最佳性能,合并敏感性为0.62(95%CI,0.54-0.71),合并特异性为0.88(95%CI,0.82-0.94),诊断比值比为20.45(95%CI,13.15-31.83)。
■在这篇评论中,没有充分的证据支持在临床实践中广泛实施TOR规则.这些发现表明,采用TOR规则可能会导致错过幸存者并增加资源利用率。
UNASSIGNED: Termination of resuscitation (TOR) rules may help guide prehospital decisions to stop resuscitation, with potential effects on patient outcomes and health resource use. Rules with high sensitivity risk increasing inappropriate transport of nonsurvivors, while rules without excellent specificity risk missed survivors. Further examination of the performance of TOR rules in estimating survival of out-of-hospital cardiac arrest (OHCA) is needed.
UNASSIGNED: To determine whether TOR rules can accurately identify patients who will not survive an OHCA.
UNASSIGNED: For this systematic
review and meta-analysis, the MEDLINE, Embase, CINAHL, Cochrane Library, and Web of Science databases were searched from database inception up to January 11, 2024. There were no restrictions on language, publication date, or time frame of the study.
UNASSIGNED: Two reviewers independently screened records, first by title and abstract and then by full text. Randomized clinical trials, case-control studies, cohort studies, cross-sectional studies, retrospective analyses, and modeling studies were included. Systematic reviews and meta-analyses were reviewed to identify primary studies. Studies predicting outcomes other than death, in-hospital studies, animal studies, and non-peer-reviewed studies were excluded.
UNASSIGNED: Data were extracted by one reviewer and checked by a second. Two reviewers assessed risk of bias using the Revised Quality Assessment Tool for Diagnostic Accuracy Studies. Cochrane Screening and Diagnostic Tests Methods Group recommendations were followed when conducting a bivariate random-effects meta-analysis. This
review followed the Preferred Reporting Items for a Systematic
Review and Meta-Analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) statement and is registered with the International Prospective Register of Systematic Reviews (CRD42019131010).
UNASSIGNED: Sensitivity and specificity tables with 95% CIs and bivariate summary receiver operating characteristic (SROC) curves were produced. Estimates of effects at different prevalence levels were calculated. These estimates were used to evaluate the practical implications of TOR rule use at different prevalence levels.
UNASSIGNED: This
review included 43 nonrandomized studies published between 1993 and 2023, addressing 29 TOR rules and involving 1 125 587 cases. Fifteen studies reported the derivation of 20 TOR rules. Thirty-three studies reported external data validations of 17 TOR rules. Seven TOR rules had data to facilitate meta-analysis. One clinical study was identified. The universal termination of resuscitation rule had the best performance, with pooled sensitivity of 0.62 (95% CI, 0.54-0.71), pooled specificity of 0.88 (95% CI, 0.82-0.94), and a diagnostic odds ratio of 20.45 (95% CI, 13.15-31.83).
UNASSIGNED: In this
review, there was insufficient robust evidence to support widespread implementation of TOR rules in clinical practice. These findings suggest that adoption of TOR rules may lead to missed survivors and increased resource utilization.