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Systematic review and meta-analysis of pre-hospital diagnostic accuracy studies
  1. Caitlin Wilson1,
  2. Clare Harley2,
  3. Stephanie Steels2
  1. 1Paramedic Emergency Service, North West Ambulance Service NHS Trust, Bolton, UK
  2. 2Faculty of Medicine and Health, University of Leeds, Leeds, UK
  1. Correspondence to Caitlin Wilson, North West Ambulance Service NHS Trust, Bolton, UK; caitlin.wilson{at}


Introduction Paramedics are involved in examining, treating and diagnosing patients. The accuracy of these diagnoses is evaluated using diagnostic accuracy studies. We undertook a systematic review of published literature to provide an overview of how accurately paramedics diagnose patients compared with hospital doctors. A bivariate meta-analysis was incorporated to examine the range of diagnostic sensitivity and specificity.

Methods We searched MEDLINE, CINAHL, Embase, AMED and the Cochrane Database from 1946 to 7 May 2016 for studies where patients had been given a diagnosis by paramedics and hospital doctors. Keywords focused on study type (‘diagnostic accuracy’), outcomes (sensitivity, specificity, likelihood ratio?, predictive value?) and setting (paramedic*, pre-hospital, ambulance, ‘emergency service?’, ‘emergency medical service?’, ‘emergency technician?’).

Results 2941 references were screened by title and/or abstract. Eleven studies encompassing 384 985 patients were included after full-text review. The types of diagnoses in one of the studies encompassed all possible diagnoses and in the other studies focused on sepsis, stroke and myocardial infarction. Sensitivity estimates ranged from 32% to 100% and specificity estimates from 14% to 100%. Eight of the studies were deemed to have a low risk of bias and were incorporated into a meta-analysis which showed a pooled sensitivity of 0.74 (0.62 to 0.82) and a pooled specificity of 0.94 (0.87 to 0.97).

Discussion Current published research suggests that diagnoses made by paramedics have high sensitivity and even higher specificity. However, the paucity and varying quality of studies indicates that further prehospital diagnostic accuracy studies are warranted especially in the field of non-life-threatening conditions.

PROSPERO registration number CRD42016039306.

  • diagnosis
  • prehospital care
  • paramedics
  • clinical
  • pre-hospital

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  • Twitter @999_Caitlin

  • Contributors CW conceived the study. All authors designed the study and established the search criteria. CW screened the references, performed the data extraction, quality assessment, synthesis and meta-analysis. CW wrote the final manuscript. CH and SS reviewed and approved the final manuscript, as well as providing guidance throughout the project.

  • Funding Health Education England/National Institute for Health Research Integrated Clinical Academic (ICA) Programme Masters in Clinical Research Studentship Scheme MRES-2015-03-020.

  • Disclaimer The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

  • Patient consent Not required.

  • Ethics approval This paper represents a systematic review of published work and separate ethical approval was therefore not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This paper represents a systematic review of published work; the data included in the paper are available in the published works reviewed.

  • Presented at 999 EMS Research Forum Conference 2018