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The aim of this systematic review and meta-analysis was to evaluate the outcomes of patients who are not transported to hospital following ambulance attendance. A database search was conducted using PubMed, Medline, Embase, CINAHL and Cochrane Library. Studies were included if they analysed the outcomes of patients who were not transported following ambulance attendance. The primary outcome of this review was subsequent presentation to an ED following a non-transport decision. Secondary outcome measures included hospital admission, subsequent presentation to alternative service provider (e.g. private physician), and death at follow up. The search yielded 1953 non-duplicate articles, of which 10 met the inclusion criteria. Three studies specified that the non-transport decision was emergency medical services (EMS)-initiated, seven studies did not specify. Meta-analysis found substantial heterogeneity between estimates (I >50%) that was likely because of differences in study design, length of follow up, patient demographic and sample size. Between 5% and 46% (pooled estimate 21%; 95% CI 11-31%) of non-transport patients subsequently presented to ED. Few (pooled estimate 8%; 95% CI 5-12%) EMS-initiated non-transport patients were admitted to hospital compared to the unspecified group (pooled estimate 40%; 95% CI 7-72%). Mortality rates were low across included studies. Studies found varying estimates for the proportion of patients discharged at the scene that subsequently presented to ED. Few patients were admitted to hospital when the non-transport decision was initiated by EMS, indicating EMS triage is a relatively safe practice. More research is needed to elucidate the context of non-transport decisions and improve access to alternative pathways.
This article was published in the following journal.
Name: Emergency medicine Australasia : EMA
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An article or book published after examination of published material on a subject. It may be comprehensive to various degrees and the time range of material scrutinized may be broad or narrow, but the reviews most often desired are reviews of the current literature. The textual material examined may be equally broad and can encompass, in medicine specifically, clinical material as well as experimental research or case reports. State-of-the-art reviews tend to address more current matters. A review of the literature must be differentiated from HISTORICAL ARTICLE on the same subject, but a review of historical literature is also within the scope of this publication type.
Articles on conferences sponsored by NIH presenting summary statements representing the majority agreement of physicians, scientists, and other professionals convening for the purpose of reaching a consensus on a subject of interest. This heading is used for NIH consensus conferences as a means of scientific communication. In indexing it is viewed as a type of review article and as a tag for any article appearing in any publication of the NIH Office of Medical Applications of Research (OMAR).
Work that is the republication of an article to correct, amplify, or restore text and data of the originally published article.
An organized procedure carried out by a select committee of professionals in evaluating the performance of other professionals in meeting the standards of their specialty. Review by peers is used by editors in the evaluation of articles and other papers submitted for publication. Peer review is used also in the evaluation of grant applications. It is applied also in evaluating the quality of health care provided to patients.
The practice of redirecting ambulances and patients seeking urgent care from one emergency department to others for various reasons such as overcrowding and shortage of skilled staff.