Table 48Clinical evidence profile: Out of hours admission

Quality assessmentEffectQuality
No of studiesDesignRisk of biasInconsistencyIndirectnessImprecisionOther considerationsPooled effect (95% CI)
Hospital mortality (assessed with: no. of patients dying in hospital)
1observational studiesno serious risk of biasno serious inconsistencyserious1serious2noneOR 1.33 (0.73 to 2.42)

⨁⨁⊝⊝

LOW

1observational studiesno serious risk of biasno serious inconsistencyno serious indirectnessno serious imprecisionnoneOR 1.07 (1.00 to 1.14)

⨁⨁⨁⨁

HIGH

30 day mortality (follow-up 30 days; assessed with: no. of patients dying within 30 days)
1observational studiesno serious risk of biasno serious inconsistencyserious1serious2noneHR 1.03 (0.89 to 1.19)

⨁⨁⊝⊝

LOW

30 day mortality (follow-up 30 days; assessed with: no. of patients dying within 30 days)
1observational studiesno serious risk of biasno serious inconsistencyserious1serious2noneHR 0.74 (0.42 to 1.3)

⨁⨁⊝⊝

LOW

30 day mortality (follow-up 30 days; assessed with: no. of patients dying within 30 days)
1observational studiesno serious risk of biasno serious inconsistencyserious1serious2noneHR 1.10 (0.6 to 2.02)

⨁⨁⊝⊝

LOW

Avoidable adverse events (assessed with: bleeding complications)
1observational studiesno serious risk of biasno serious inconsistencyserious1serious2noneOR 1.47 (0.97 to 2.23)

⨁⨁⊝⊝

LOW

Avoidable adverse events (follow-up 30 days; assessed with: MACE (death, recurrent MI, target vessel vascularisation))
1observational studiesno serious risk of biasno serious inconsistencyserious1serious2noneHR 0.81 (0.54 to 1.22)

⨁⨁⊝⊝

LOW

1

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.

2

Downgraded by 1 increment if the confidence interval crossed the null line.

From: Chapter 41, Cost-effectiveness analyses

Cover of Emergency and acute medical care in over 16s: service delivery and organisation
Emergency and acute medical care in over 16s: service delivery and organisation.
NICE Guideline, No. 94.
National Guideline Centre (UK).
Copyright © NICE 2018.

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