Systematic review and meta-analysis of pre-hospital diagnostic accuracy studies
Wilson, Caitlin
Harley, Clare Steels, Stephanie
Harley, Clare
Steels, Stephanie
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Abstract
https://emj.bmj.com/content/35/12/757.long.
Introduction Paramedics are involved in examining,
treating and diagnosing patients. The accuracy of these
diagnoses is evaluated using diagnostic accuracy studies.
We undertook a systematic review of published literature
to provide an overview of how accurately paramedics
diagnose patients compared with hospital doctors. A
bivariate meta-analysis was incorporated to examine the
range of diagnostic sensitivity and specificity.
Methods We searched MEDLINE, CINAHL, Embase,
AMED and the Cochrane Database from 1946 to 7
May 2016 for studies where patients had been given a
diagnosis by paramedics and hospital doctors. Keywords
focused on study type (’diagnostic accuracy’), outcomes
(sensitivity, specificity, likelihood ratio?, predictive value?)
and setting (paramedic*, pre-hospital, ambulance,
’emergency service?’, ’emergency medical service?’,
’emergency technician?’).
Results 2941 references were screened by title and/
or abstract. Eleven studies encompassing 384 985
patients were included after full-text review. The types of
diagnoses in one of the studies encompassed all possible
diagnoses and in the other studies focused on sepsis,
stroke and myocardial infarction. Sensitivity estimates
ranged from 32% to 100%and specificity estimates from
14% to 100%. Eight of the studies were deemed to have
a low risk of bias and were incorporated into a metaanalysis which showed a pooled sensitivity of 0.74 (0.62
to 0.82) and a pooled specificity of 0.94 (0.87 to 0.97).
Discussion Current published research suggests that
diagnoses made by paramedics have high sensitivity and
even higher specificity. However, the paucity and varying
quality of studies indicates that further prehospital
diagnostic accuracy studies are warranted especially in
the field of non-life-threatening conditions.
https://emj.bmj.com/content/emermed/35/12/757.full.pdf
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
http://dx.doi.org/10.1136/emermed-2018-207588