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Chou R, Korthuis PT, McCarty D, et al. Management of Suspected Opioid Overdose With Naloxone by Emergency Medical Services Personnel [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2017 Nov. (Comparative Effectiveness Reviews, No. 193.)
Management of Suspected Opioid Overdose With Naloxone by Emergency Medical Services Personnel [Internet].
Show detailsTable E-1Key Question 1: Risk of bias ratings of randomized controlled trials
| Author, Year | Randomization adequate? | Allocation concealment adequate? | Groups similar at baseline? | Eligibility criteria specified? | Outcome assessors masked? | Care provider masked? | Patient masked? | Reporting of Attrition, Crossovers, Adherence, and Contamination | Loss to Followup: Differential/High | Intention-to-Treat Analysis | Postrandomization Exclusions | Outcomes Prespecified | Funding Source | Risk of Bias |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Kerr, 2009 | Yes | Yes | No | Yes | No | No | No | Yes | No | Yes | Yes (3.4%) | Yes | Government | Medium |
| Kelly, 2005 | Method NR | Yes | Yes, There were some differences in setting but I don’t think these were major or should impact the results | Yes | No | No | No | Yes | No | Yes | Yes (14.9%) | Yes | Grant | Medium |
| Sabzghabaee, 2014 | Yes | Unclear | Some differences in the type of opioid. | Yes | Unclear | Unclear | Unclear | No | Unclear | Unclear | Unclear, but states there were exclusions | Yes | University | High |
NR = not reported
Table E-2Key Question 1: Risk of bias ratings of observational studies
| Author, Year | Did the study attempt to enroll a random sample or consecutive patients meeting inclusion criteria (inception cohort)? | Were the groups comparable at baseline? | Did the study use accurate methods for ascertaining exposures, potential confounders, and outcomes? | Were outcome assessors and/or data analysts blinded to treatment? | Did the article report attrition and missing data? | Did the study perform appropriate statistical analyses on potential confounders? | Is there important differential attrition or missing data or overall high attrition or missing data? | Were outcomes prespecified and defined, and ascertained using accurate methods? | Risk of Bias | Comments |
|---|---|---|---|---|---|---|---|---|---|---|
| Merlin, 2010 | Yes | No. Differences in congestion evidence and naloxone dose given | Yes | No | Yes | No | No | Yes | High | Analysis restricted to patients with “confirmed opioid overdose” (criteria not specified) |
| Robertson, 2009 | Unclear | No | Yes | No | Unclear | No | Unclear | Yes | High | |
| Sporer, 1996 | Yes | Unclear | Yes | No | No | No | No | Yes | High | Analysis restricted to patients who met criteria for presumed opioid overdose |
| Wanger, 1998 | Yes | Yes | Yes | No | Yes | No | No | Yes | High | Excluded 25 patients due to inappropriate use of naloxone protocol (respiratory rate ≥10 breaths/minute) |
Table E-3Key Question 4: Risk of bias ratings of observational studies
| Author, Year | Did the study attempt to enroll a random sample or consecutive patients meeting inclusion criteria (inception cohort)? | Were the groups comparable at baseline? | Did the study use accurate methods for ascertaining exposures, potential confounders, and outcomes? | Were outcome assessors and/or data analysts blinded to treatment? | Did the article report attrition and missing data? | Did the study perform appropriate statistical analyses on potential confounders? | Is there important differential attrition and missing data or overall high attrition and missing data? | Were outcomes prespecified and defined, and ascertained using accurate methods? | Risk of Bias |
|---|---|---|---|---|---|---|---|---|---|
| Boyd, 2006 | Yes | Unclear | Yes | No | Yes | No | Yes | No | High |
| Levine, 2016 | Yes | NA (single-arm cohort) | Yes | Unclear | No | NA | Unclear | Yes | High |
| Rudolph, 2011 | Yes | NA (single-arm cohort) | Yes | No | Yes | No | Unclear | Yes | High |
| Vilke, 1999 | Yes | NA (single-arm cohort) | Yes | Unclear | No | NA | Unclear | Yes | High |
| Vilke, 2003 | Yes | NA (single-arm cohort) | Yes | Unclear | No | NA | Unclear | Yes | High |
| Wampler, 2011 | Yes | NA (single-arm cohort) | Yes | Unclear | No | NA | Unclear | Yes | High |
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