Survival and cost-effectiveness of helicopter versus ground emergency medical services: a systematic review and meta-analysis with meta-regression and trial sequential analysis.
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引用次数: 0
Abstract
Objective: To synthesise the available literature comparing outcomes of ground emergency medical services (GEMS) and helicopter emergency medical services (HEMS).
Methods: We conducted a systematic review and meta-analysis, reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from 1995 to 2024. Studies comparing HEMS with GEMS in emergency conditions were eligible.
Results: The search retrieved 1,595 records; 181 studies were assessed in full text, and 77 were included, accounting for a pooled population of 2,618,483 patients. The relative risk (RR) of mortality in HEMS compared with GEMS was 1.13 (95% CI 0.96-1.34). The RR of disability was 1.24 (95% CI 0.99-1.55). The total incremental net benefit was €980,000 per QALY per patient, based on cost-effectiveness studies and a willingness-to-pay threshold of €35 million per QALY per patient.
Conclusion: Very low-quality evidence, due to high heterogeneity, potential confounding from registry-based enrolment, and possible multiple imputation bias, suggested that HEMS did not improve survival compared with GEMS. High-quality studies are needed to further investigate this question.
Clinical trial registration: PROSPERO: International prospective register of systematic reviews, 2024, CRD42024628317.
目的：综合现有文献，比较地面紧急医疗服务（GEMS）和直升机紧急医疗服务（HEMS）的效果。方法：我们进行了系统评价和荟萃分析，按照系统评价和荟萃分析（PRISMA）指南的首选报告项目进行报告。检索1995年至2024年的PubMed、Scopus、Web of Science和护理与相关健康文献累积索引（CINAHL）。比较HEMS和GEMS在紧急情况下的研究是合格的。结果：检索到1595条记录；全文评估了181项研究，其中77项纳入，共纳入2,618,483例患者。与GEMS相比，HEMS死亡率的相对危险度（RR）为1.13 （95% CI 0.96-1.34）。致残的RR为1.24 （95% CI 0.99-1.55）。根据成本效益研究和每位患者每位QALY 3500万欧元的支付意愿阈值，每位患者每位QALY的总增量净收益为98万欧元。结论：非常低质量的证据表明，与GEMS相比，HEMS并没有提高生存率，这是由于高度的异质性、基于注册的入组的潜在混淆以及可能的多重归因偏差。需要高质量的研究来进一步调查这个问题。临床试验注册：PROSPERO：国际前瞻性系统评价注册，2024,CRD42024628317。
期刊介绍：
The primary topics of interest in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (SJTREM) are the pre-hospital and early in-hospital diagnostic and therapeutic aspects of emergency medicine, trauma, and resuscitation. Contributions focusing on dispatch, major incidents, etiology, pathophysiology, rehabilitation, epidemiology, prevention, education, training, implementation, work environment, as well as ethical and socio-economic aspects may also be assessed for publication.
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