| Quality assessment | Effect | Quality | ||||||
|---|---|---|---|---|---|---|---|---|
| No of studies | Design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Pooled effect (95% CI) | |
| Hospital mortality (assessed with: No. of patients dying in hospital) | ||||||||
| 1 | observational studies | no serious risk of bias | no serious inconsistency | no serious indirectness | no serious imprecision | none | Adjusted OR 1.10 (1.08 to 1.12) |
⨁⨁⨁⨁ HIGH |
| Hospital mortality (assessed with: No. of patients dying in hospital) | ||||||||
| 1 | observational studies | no serious risk of bias | no serious inconsistency | no serious indirectness | no serious imprecision | none | Adjusted OR 1.10 (1.08 to 1.12) |
⨁⨁⨁⨁ HIGH |
| Hospital mortality (assessed with: No. of patients dying in hospital) | ||||||||
| 1 | observational studies | no serious risk of bias | no serious inconsistency | no serious indirectness | serious1 | none | Adjusted OR 1.15 (0.89 to 1.49) |
⨁⨁⨁⊝ MODERATE |
| Hospital mortality (follow-up 7 days; assessed with: No. of patients dying in hospital) | ||||||||
| 1 | observational studies | serious2 | no serious inconsistency | no serious indirectness | serious1 | none | Adjusted OR 1.75 (0.75 to 4.09) |
⨁⨁⊝⊝ LOW |
| Hospital mortality (assessed with: No. of patients dying in hospital) | ||||||||
| 1 | observational studies | no serious risk of bias | no serious inconsistency | no serious indirectness | no serious imprecision | none | Adjusted HR 2.10 (1.13 to 3.9) |
⨁⨁⨁⨁ HIGH |
| Hospital mortality (assessed with: No. of patients dying in hospital) | ||||||||
| 2 | observational studies | no serious risk of bias | no serious inconsistency | no serious indirectness | no serious imprecision | none |
Adjusted HR 1.14 (1.12 to 1.15) Range of HR: 1.11-1.16 |
⨁⨁⨁⨁ HIGH |
| Hospital mortality (follow-up 30 days; assessed with: No. of patients dying in hospital) | ||||||||
| 1 | observational studies | serious2 | no serious inconsistency | serious3 | serious1 | none | Adjusted OR 0.93 (0.75 to 1.15) |
⨁⊝⊝⊝ VERY LOW |
| Hospital mortality (assessed with: No. of patients dying in hospital) | ||||||||
| 1 | observational studies | no serious risk of bias | no serious inconsistency | no serious indirectness | no serious imprecision | none | Adjusted OR 1.09 (1.05 to 1.13) |
⨁⨁⨁⨁ HIGH |
| Hospital mortality (assessed with: No. of patients dying in hospital) | ||||||||
| 1 | observational studies | no serious risk of bias | no serious inconsistency | no serious indirectness | serious1 | none | Adjusted RR 0.98 (0.91 to 1.06) |
⨁⨁⨁⊝ MODERATE |
| Hospital mortality (follow-up 7 days; assessed with: No. of patients dying in hospital) | ||||||||
| 1 | observational studies | serious2 | no serious inconsistency | no serious indirectness | no serious imprecision | none | Adjusted OR 1.18 (1.12 to 1.24) |
⨁⨁⨁⊝ MODERATE |
| Hospital mortality (follow-up 30 days; assessed with: No. of patients dying in hospital) | ||||||||
| 1 | observational studies | serious2 | no serious inconsistency | no serious indirectness | no serious imprecision | none |
Adjusted OR 1.08 (1.05 to 1.1) Range of HR: 1.07-1.08 |
⨁⨁⨁⊝ MODERATE |
| Hospital mortality (follow-up 30 days; assessed with: No. of patients dying in hospital) | ||||||||
| 1 | observational studies | serious2 | no serious inconsistency | no serious indirectness | no serious imprecision | none |
Adjusted OR 1.02 (1.00 to 1.03) Range of HR: 0.96-1.03 |
⨁⨁⨁⊝ MODERATE |
| 30 day survival (follow-up 30 days; assessed with: No. of patients surviving to 30 days post admission) (weekend 8am-7.59pm) | ||||||||
| 1 | observational studies | no serious risk of bias | no serious inconsistency | no serious indirectness | serious1 | none | Adjusted OR 1.03 (0.95 to 1.12) |
⨁⨁⨁⊝ MODERATE |
| 30 day survival (follow-up 30 days; assessed with: No. of patients surviving to 30 days post admission) (weekend 8pm-7.59am) | ||||||||
| 1 | observational studies | no serious risk of bias | no serious inconsistency | no serious indirectness | serious1 | none | Adjusted OR 0.89 (0.78 to 1.02) |
⨁⨁⨁⊝ MODERATE |
| 30 day mortality (follow-up 30 days; assessed with: No. of patients dying within 30 days of admission) | ||||||||
| 1 | observational studies | no serious risk of bias | no serious inconsistency | no serious indirectness | no serious imprecision | none | Adjusted OR 1.14 (1.06 to 1.23) |
⨁⨁⨁⨁ HIGH |
| 30 day mortality (follow-up 30 days; assessed with: No. of patients dying within 30 days of admission) (A&E admissions) | ||||||||
| 1 | observational studies | no serious risk of bias | no serious inconsistency | no serious indirectness | no serious imprecision | none | Adjusted OR 1.05 (1.04 to 1.07) |
⨁⨁⨁⨁ HIGH |
| 30 day mortality (follow-up 30 days; assessed with: No. of patients dying within 30 days of admission) (direct admissions) | ||||||||
| 1 | observational studies | no serious risk of bias | no serious inconsistency | no serious indirectness | no serious imprecision | none | Adjusted OR 1.21 (1.16 to 1.26) |
⨁⨁⨁⨁ HIGH |
| 30 day mortality (follow-up 30 days; assessed with: No. of patients dying within 30 days) | ||||||||
| 3 | observational studies | no serious risk of bias | serious4 | no serious indirectness | no serious imprecision | none |
Adjusted HR 1.13 (1.1 to 1.15) Range of HR: 0.96-1.15 |
⨁⨁⨁⊝ MODERATE |
| Avoidable adverse events (assessed with: re-bleeding) | ||||||||
| 1 | observational studies | no serious risk of bias | no serious inconsistency | serious3 | serious1 | none | Adjusted OR 0.91 (0.74 to 1.12) |
⨁⨁⊝⊝ LOW |
| Avoidable adverse events (assessed with: surgery/radiology) | ||||||||
| 1 | observational studies | no serious risk of bias | no serious inconsistency | serious3 | serious1 | none | Adjusted OR 1.13 (0.81 to 1.58) |
⨁⨁⊝⊝ LOW |
| Avoidable adverse events (assessed with: red cell transfusion | ||||||||
| 1 | observational studies | no serious risk of bias | no serious inconsistency | serious3 | serious1 | none | Adjusted OR 1.12 (0.94 to 1.33) |
⨁⨁⊝⊝ LOW |
| Avoidable adverse events (follow-up 24 hours; assessed with: inadequate response to NEWS) | ||||||||
| 1 | observational studies | serious2 | no serious inconsistency | no serious indirectness | no serious imprecision | prospective single centre study, unclear whether staff were aware of the study and outcome was appropriate clinical response - potential for performance bias | Adjusted OR 4.15 (2.24 to 7.69) |
⨁⨁⨁⊝ MODERATE |
| Avoidable adverse events (assessed with: aspiration pneumonia) | ||||||||
| 1 | observational studies | no serious risk of bias | no serious inconsistency | no serious indirectness | no serious imprecision | none | Adjusted OR 1.11 (1.04 to 1.18) |
⨁⨁⨁⨁ HIGH |
| Length of stay (follow-up 56 days; assessed with: discharge to usual place of residence within 56 days) | ||||||||
| 1 | observational studies | no serious risk of bias | no serious inconsistency | no serious indirectness | no serious imprecision | none | Adjusted OR 0.92 (0.88 to 0.96) |
⨁⨁⨁⨁ HIGH |
Downgraded by 1 increment if the confidence interval crossed the null line.
Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias.
Downgraded by 1 increment if the majority of evidence included an indirect population or 2 increments if the majority of the evidence included a very indirect population.
Downgraded by 1 or 2 increments because heterogeneity, I2=50%, p=0.04, unexplained by subgroup analysis.
From: Chapter 41, Cost-effectiveness analyses
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