无目击者院外心脏骤停的决定因素：一项系统综述（HL-D-26-00618）。
完整摘要 · 中文译文
背景：约半数院外心脏骤停（OHCA）病例为无人目击，生存率低于5%。尽管早期识别对于改善结局至关重要，但与无人目击OHCA相关的因素尚未被系统综述。 目的：系统综述并综合关于无人目击OHCA决定因素的现有证据。 方法：我们纳入了经过同行评审的观察性研究，这些研究探讨了人口学、社会经济、临床或情境因素与成人OHCA目击状态的关联。对研究场景、语言或发表年份不设限制。对MEDLINE、Embase和Web of Science核心合集从建库至2025年7月17日进行了系统检索。使用QUIPS工具评估偏倚风险。研究结果按决定因素领域进行叙述性综合，总结研究数量、效应方向、统计学显著性和一致性。 结果：共分析22项研究，纳入210,028名个体。女性性别和发生于家中的心脏骤停与无人目击OHCA的关联最为一致。有限的证据（主要来自未调整分析）提示，黑人个体、社会经济地位较低或居住在更贫困地区者、1型糖尿病患者、精神疾病患者，以及发生于夜间、睡眠期间或居住区或农村环境中的心脏骤停，其无人目击OHCA发生率较高。 结论：本系统综述识别出若干与无人目击OHCA相关的因素，其中最为一致的证据 针对女性以及在家中发生的逮捕。这些发现可能有助于指导有针对性的预防和公共卫生策略。
完整摘要 · 英文原文
BACKGROUND: Approximately half of all out-of-hospital cardiac arrest (OHCA) cases are unwitnessed, with survival rates below 5%. Although early recognition is critical for improving outcomes, factors associated with unwitnessed OHCA have not been systematically reviewed. OBJECTIVES: To systematically review and synthesize the available evidence on determinants of unwitnessed OHCA. METHODS: We included peer-reviewed observational studies investigating associations between demographic, socioeconomic, clinical, or situational factors and witnessed status of OHCA in adults. No restrictions were placed on setting, language, or publication year. A systematic search of MEDLINE, Embase, and Web of Science Core Collection was performed from inception to July 17, 2025. Risk of bias was assessed using the QUIPS tool. Findings were synthesized narratively by determinant domain, summarizing study counts, effect directions, statistical significance, and consistency. RESULTS: Twenty-two studies including 210,028 individuals were analyzed. Female sex and arrest occurring at home were most consistently associated with unwitnessed OHCA. Limited evidence, predominantly from unadjusted analyses, suggested higher rates of unwitnessed OHCA among Black individuals, those with low socioeconomic status or living in more deprived areas, individuals with type I diabetes, psychiatric illness, and arrests occurring at night, during sleep, or in residential or rural settings. CONCLUSION: This systematic review identified several factors associated with unwitnessed OHCA, with the most consistent evidence for female sex and arrests occurring at home. These findings may help guide targeted prevention and public health strategies.