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Table 4 Influencing factors

From: Adherence to guidelines and protocols in the prehospital and emergency care setting: a systematic review

Domain Influencing factor Medical condition
Patient characteristics Age Cardiology
• Patients with ST-segment elevation myocardial infarction aged ≤75 years were more likely to receive care in accordance with the guideline[18]
• Patients with acute myocardial infarction aged <55 years were more likely to receive aspirin[34]
Pulmonology
• Patients with pneumonia aged <18 years were more likely to receive recommended antibiotics[34]
• Patients with pneumonia aged <18 years were less likely to be monitored with pulse oximetry[34]
• Patients with suspected pulmonary embolism aged >75 years were less likely to be diagnosed in accordance with the guideline[22]
• Children with bronchiolitis whose gestational age was 30 weeks were more likely to receive palivizumab compared to children whose gestational age was 32 weeks[37]
Other
• Patients with urinary complaints aged >19 years were more likely to be taken their sexual history[51]
• Children with fever who were aged 28–59 days were more likely to receive complete blood cell count, blood culture, urine culture, cerebrospinal fluid culture and viral studies compared to children who were aged 60–90 days[42]
  Gender Cardiology
• Male patients with acute myocardial infarction were more likely to receive ß-blockers[34]
• Male patients with cardiac arrest were more likely to receive treatment in accordance with the guidelines[26]
  Weight Pulmonology
• Children with bronchiolitis with birth-weight <3lbs were more likely to receive palivizumab[37]
  Current disease/condition Cardiology
• Patients with ST-segment elevation myocardial infarction with a symptom onset 08.00-20.00 were more likely to receive care in accordance with the guideline than patients with a symptom onset 20.00-08.00[18]
• Patients with ST-segment elevation myocardial infarction with a typical STEMI on the ECG were more likely to receive care in accordance with the guideline compared to patients without a typical STEMI on the ECG[18]
• Patients with cardiac arrest of whom the arrest was witnessed or with an initial rhythm of VF/VT were more likely to receive care in accordance with the guideline than patients with an unwitnessed arrest of initial rhythm other than VF/VT[26]
• Patients with cardiac arrest with a longer time interval between return of spontaneous circulation and hospital admission were more likely to receive care in accordance with the guideline compared to patients with a shorter time interval[26]
Pulmonology
• Patients with suspected pulmonary embolism currently receiving anticoagulation were less likely to be diagnosed in accordance with the guideline compared to patients with anticoagulation[22]
• Children with bronchiolitis with a history of wheezing were more likely to receive palivizumab than patients without a history of wheezing[37]
Other
• Patients with urinary complaints with a history of fever were more likely to be taken their sexual history than patients without a history of fever[51]
• Patients with urinary complaints with genital discharge were more likely to be taken their sexual history than patients without genital discharge[51]
  Race Cardiology
• Patients with acute myocardial infarction of Hispanic race were less likely to receive aspirin compared to patients of white or nonwhite race[34]
Pulmonology
• Patients with pneumonia of nonwhite race were less likely to be monitored with pulse oximetry compared to patients of white or hispanic race[34]
  Insurance Cardiology
• Patients with acute myocardial infarction with a private insurance were more likely to receive aspirin than patients with a medicare or Medicaid insurance[34]
Pulmonology
• Patients with pneumonia with a private insurance were more likely to receive antibiotics than patients with a medicare of Medicaid insurance[34]
  Comorbidity Cardiology
• Patients with cardiac arrest with a prior neurological disease were less likely to receive care in accordance with the guideline compared to patients without prior neurological disease[26]
Pulmonology
• Patients with suspected pulmonary embolism with known heart failure, known chronic lung disease or current/recent pregnancy were less likely to be diagnosed in accordance with the guideline than patients without known heart failure, chronic lung disease or current/recent pregnancy[22]
• Patients with suspected pulmonary embolism with previous thromboembolism were more likely to be diagnosed in accordance with the guideline than patients without previous thromboembolism[22]
  Time of presentation Other
• Patients with urinary complaints who presented in the evening were more likely to be taken their sexual history compared to patients who presented in over daytime[51]
Organisational factors Location Cardiology
• Patients with ST-segment elevation myocardial infarction treated in an urban ED were more likely to be treated in accordance with the guideline compared to patients treated in a rural ED[18]
• Patients with acute myocardial infarction treated in a Midwest or Southern ED were less likely to receive ß-blockers compared to patients treated in a northeast or west ED[34]
Pulmonology
• Patients with pneumonia treated in a Southern ED are less likely to receive antibiotics compared to patient treated in a northeast, west or midwest ED[34]
• Patients with pneumonia treated in a metropolitan ED are more likely to receive antibiotics and are more likely to be monitored with pulse oximetry compared to patients in a non-metropolitan ED[34]
• Patients with asthma treated in medical centres were more likely to be diagnosed with oximetry or arterial blood gas compared to patients in regional and district EDs[20]
  Presence of a physician Cardiology
• Patients with cardiac arrest where a prehospital physician was present on scene were more likely to receive care in accordance with the guideline than patients without prehospital physician presence[26]
  Ownership of the ED Cardiology
• Patients with acute myocardial infarction treated in an ED with governmental or non-federal ownership are less likely to receive aspirin than patients treated in an nonprofit or proprietary ED[34]
Pulmonology
   • Patients with pneumonia treated in an ED with governmental or non-federal ownership are less likely to receive antibiotics compared to patients treated in an nonprofit or proprietary ED[34]