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Rapid response systems: a systematic review and meta-analysis.

Maharaj R, Raffaele I, Wendon J - Crit Care (2015)

Bottom Line: Although rapid response system teams have been widely adopted by many health systems, their effectiveness in reducing hospital mortality is uncertain.The implementation of RRS has been associated with an overall reduction in hospital mortality in both the adult (RR 0.87, 95 % CI 0.81-0.95, p<0.001) and paediatric (RR=0.82 95 % CI 0.76-0.89) in-patient population.Meta-regression did not identify the presence of a physician in the rapid response system to be significantly associated with a mortality reduction.

View Article: PubMed Central - PubMed

Affiliation: Kings College London, Denmark Hill, London, SE5 9RW, UK. ritesh.maharaj@kcl.ac.uk.

ABSTRACT

Introduction: Although rapid response system teams have been widely adopted by many health systems, their effectiveness in reducing hospital mortality is uncertain. We conducted a meta-analysis to examine the impact of rapid response teams on hospital mortality and cardiopulmonary arrest.

Method: We conducted a systematic review of studies published from January 1, 1990, through 31 December 2013, using PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and the Cochrane Library. We included studies that reported data on the primary outcomes of ICU and in-hospital mortality or cardiopulmonary arrests.

Results: Twenty-nine eligible studies were identified. The studies were analysed in groups based on adult and paediatric trials that were further sub-grouped on methodological design. There were 5 studies that were considered either cluster randomized control trial, controlled before after or interrupted time series. The remaining studies were before and after studies without a contemporaneous control. The implementation of RRS has been associated with an overall reduction in hospital mortality in both the adult (RR 0.87, 95 % CI 0.81-0.95, p<0.001) and paediatric (RR=0.82 95 % CI 0.76-0.89) in-patient population. There was substantial heterogeneity in both populations. The rapid response system team was also associated with a reduction in cardiopulmonary arrests in adults (RR 0.65, 95 % CI 0.61-0.70, p<0.001) and paediatric (RR=0.64 95 % CI 0.55-0.74) patients.

Conclusion: Rapid response systems were associated with a reduction in hospital mortality and cardiopulmonary arrest. Meta-regression did not identify the presence of a physician in the rapid response system to be significantly associated with a mortality reduction.

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Related in: MedlinePlus

Contour-enhanced funnel plot. If studies appear to be missing in areas of low statistical significance, then it is possible that the asymmetry is due to publication bias. Conversely, if the area in which studies are perceived to be missing are of high statistical significance, then publication bias is a less likely cause of the funnel asymmetry
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Fig4: Contour-enhanced funnel plot. If studies appear to be missing in areas of low statistical significance, then it is possible that the asymmetry is due to publication bias. Conversely, if the area in which studies are perceived to be missing are of high statistical significance, then publication bias is a less likely cause of the funnel asymmetry

Mentions: Publication bias refers to the phenomenon in which studies with less favourable results are less likely to be published than those with favourable results. Funnel plots appear asymmetric because of systematic suppression of studies. There are many factors other than publication bias that may explain funnel plot asymmetry, such as differential study quality or small study effects. A contour-enhanced funnel plot aims to disentangle these causes of funnel plot asymmetry. Generally, the level of statistical significance may drive publication bias, with studies that do not reach the perceived milestones of significance (e.g. p <0.05) less likely to be published. A contour-enhanced funnel plot overlays the contours of statistical significance on a funnel plot. This provides a novel method to assess whether the studies that exist are areas of statistical significance or whether there are areas where studies are missing that correspond to areas of low statistical significance. If studies are missing in areas of low statistical significance, then there may be publication bias. If studies are perceived to be missing, then publication bias is less likely. The contour-enhanced funnel plot was asymmetric but the perceived missing studies were in areas of high statistical significance, making publication bias a less likely cause of funnel asymmetry (Fig. 4).Fig. 4


Rapid response systems: a systematic review and meta-analysis.

Maharaj R, Raffaele I, Wendon J - Crit Care (2015)

Contour-enhanced funnel plot. If studies appear to be missing in areas of low statistical significance, then it is possible that the asymmetry is due to publication bias. Conversely, if the area in which studies are perceived to be missing are of high statistical significance, then publication bias is a less likely cause of the funnel asymmetry
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4489005&req=5

Fig4: Contour-enhanced funnel plot. If studies appear to be missing in areas of low statistical significance, then it is possible that the asymmetry is due to publication bias. Conversely, if the area in which studies are perceived to be missing are of high statistical significance, then publication bias is a less likely cause of the funnel asymmetry
Mentions: Publication bias refers to the phenomenon in which studies with less favourable results are less likely to be published than those with favourable results. Funnel plots appear asymmetric because of systematic suppression of studies. There are many factors other than publication bias that may explain funnel plot asymmetry, such as differential study quality or small study effects. A contour-enhanced funnel plot aims to disentangle these causes of funnel plot asymmetry. Generally, the level of statistical significance may drive publication bias, with studies that do not reach the perceived milestones of significance (e.g. p <0.05) less likely to be published. A contour-enhanced funnel plot overlays the contours of statistical significance on a funnel plot. This provides a novel method to assess whether the studies that exist are areas of statistical significance or whether there are areas where studies are missing that correspond to areas of low statistical significance. If studies are missing in areas of low statistical significance, then there may be publication bias. If studies are perceived to be missing, then publication bias is less likely. The contour-enhanced funnel plot was asymmetric but the perceived missing studies were in areas of high statistical significance, making publication bias a less likely cause of funnel asymmetry (Fig. 4).Fig. 4

Bottom Line: Although rapid response system teams have been widely adopted by many health systems, their effectiveness in reducing hospital mortality is uncertain.The implementation of RRS has been associated with an overall reduction in hospital mortality in both the adult (RR 0.87, 95 % CI 0.81-0.95, p<0.001) and paediatric (RR=0.82 95 % CI 0.76-0.89) in-patient population.Meta-regression did not identify the presence of a physician in the rapid response system to be significantly associated with a mortality reduction.

View Article: PubMed Central - PubMed

Affiliation: Kings College London, Denmark Hill, London, SE5 9RW, UK. ritesh.maharaj@kcl.ac.uk.

ABSTRACT

Introduction: Although rapid response system teams have been widely adopted by many health systems, their effectiveness in reducing hospital mortality is uncertain. We conducted a meta-analysis to examine the impact of rapid response teams on hospital mortality and cardiopulmonary arrest.

Method: We conducted a systematic review of studies published from January 1, 1990, through 31 December 2013, using PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and the Cochrane Library. We included studies that reported data on the primary outcomes of ICU and in-hospital mortality or cardiopulmonary arrests.

Results: Twenty-nine eligible studies were identified. The studies were analysed in groups based on adult and paediatric trials that were further sub-grouped on methodological design. There were 5 studies that were considered either cluster randomized control trial, controlled before after or interrupted time series. The remaining studies were before and after studies without a contemporaneous control. The implementation of RRS has been associated with an overall reduction in hospital mortality in both the adult (RR 0.87, 95 % CI 0.81-0.95, p<0.001) and paediatric (RR=0.82 95 % CI 0.76-0.89) in-patient population. There was substantial heterogeneity in both populations. The rapid response system team was also associated with a reduction in cardiopulmonary arrests in adults (RR 0.65, 95 % CI 0.61-0.70, p<0.001) and paediatric (RR=0.64 95 % CI 0.55-0.74) patients.

Conclusion: Rapid response systems were associated with a reduction in hospital mortality and cardiopulmonary arrest. Meta-regression did not identify the presence of a physician in the rapid response system to be significantly associated with a mortality reduction.

Show MeSH
Related in: MedlinePlus