Rapid response systems (RRSs) improve patients’ safety, but the role of dedicated doctors within these systems remains controversial. We aimed to evaluate patient survival rates and differences in types of interventions performed depending on the presence of dedicated doctors in the RRS. Patients managed by the RRSs of 9 centers in South Korea from January 1, 2016, through December 31, 2017, were included retrospectively. We used propensity score-matched analysis to balance patients according to the presence of dedicated doctors in the RRS. The primary outcome was in-hospital survival. The secondary outcomes were the incidence of interventions performed. A sensitivity analysis was performed with the subgroup of patients diagnosed with sepsis or septic shock. After propensity score matching, 2981 patients were included per group according to the presence of dedicated doctors in the RRS. The presence of the dedicated doctors was not associated with patients’ overall likelihood of survival (hazard ratio for death 1.05, 95% confidence interval [CI] 0.93‒1.20). Interventions, such as arterial line insertion (odds ratio [OR] 25.33, 95% CI 15.12‒42.44) and kidney replacement therapy (OR 10.77, 95% CI 6.10‒19.01), were more commonly performed for patients detected using RRS with dedicated doctors. The presence of dedicated doctors in the RRS was associated with better survival of patients with sepsis or septic shock (hazard ratio for death 0.62, 95% CI 0.39‒0.98) and lower intensive care unit admission rates (OR 0.53, 95% CI 0.37‒0.75). The presence of dedicated doctors within the RRS was not associated with better survival in the overall population but with better survival and lower intensive care unit admission rates for patients with sepsis or septic shock.

中文翻译：

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快速反应系统中专职医生的存在与患者结果之间的关系：多中心回顾性队列研究


快速反应系统（RRS）可提高患者的安全，但专职医生在这些系统中的作用仍然存在争议。我们的目的是评估患者的生存率以及根据 RRS 中是否有专职医生进行的干预措施类型的差异。回顾性纳入2016年1月1日至2017年12月31日期间韩国9个中心的RRS管理的患者。我们使用倾向评分匹配分析，根据 RRS 中是否有专职医生来平衡患者。主要结局是院内生存率。次要结果是所执行干预措施的发生率。对诊断为败血症或败血性休克的患者亚组进行了敏感性分析。经过倾向评分匹配后，根据 RRS 中是否有专职医生，每组纳入 2981 名患者。专职医生的存在与患者的总体生存可能性无关（死亡风险比 1.05，95% 置信区间 [CI] 0.93−1.20）。对于由专职医生使用 RRS 检测到的患者，更常见的是动脉导管插入（比值比 [OR] 25.33，95% CI 15.12-42.44）和肾脏替代治疗（OR 10.77，95% CI 6.10-19.01）等干预措施。 RRS 中专职医生的存在与败血症或败血性休克患者的更好生存率（死亡风险比 0.62，95% CI 0.39-0.98）和更低的重症监护病房入院率（OR 0.53，95% CI 0.37-0.37- 0.75）。 RRS 中专职医生的存在与总体人群的更好生存率无关，但与脓毒症或感染性休克患者的更好生存率和更低的重症监护病房入院率相关。