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Meta-Analysis
. 2015 Jun 12;19(1):254.
doi: 10.1186/s13054-015-0973-y.

Rapid response systems: a systematic review and meta-analysis

Ritesh Maharaj  1   2   3 , Ivan Raffaele  4 , Julia Wendon  5   6
Affiliations
Meta-Analysis

Rapid response systems: a systematic review and meta-analysis

Ritesh Maharaj et al. Crit Care. .

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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Figures

Fig. 1
Fig. 1
Literature search flow diagram
Fig. 2
Fig. 2
Forest plot of the effect of rapid response system teams on hospital mortality in adult in-patients. Weights are calculated from random-effects analysis. CBA controlled before–after, CCO critical care outreach, CI confidence interval, ITS interrupted time series, RCT randomized controlled trial
Fig. 3
Fig. 3
Forest plot of the effect of rapid response system teams on hospital mortality in paediatric in-patients. Weights are calculated from random-effects analysis. CBA controlled before–after, CI confidence interval, ITS interrupted time series, RCT randomized controlled trial
Fig. 4
Fig. 4
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
See this image and copyright information in PMC

Comment in

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