Twenty-six studies were included in the review: 16 controlled cohort studies, five system comparison studies and five before-and-after studies. Twelve studies followed patients until hospital or discharge from the intensive care unit. Reported follow-up for the other studies ranged from one month to three years.
Fourteen studies showed that compared with treatment by paramedical personnel, there was a significantly higher survival rate in the group with treatment by physicians. However, three studies showed a significantly lower rate in survival in the group with treatment by physicians. Nine studies did not demonstrate a significant difference in survival rate between the two groups.
In the 19 studies of trauma patients (number of patients in the intervention group ranged from 25 to 14,702), nine studies reported that physician treatment significantly increased survival compared with paramedical treatment.
In the five studies of patients with out of hospital cardiac arrest (number of patients in the intervention group ranging from nine to <100), four studies reported that physician treatment significantly increased survival compared with paramedical treatment.
The two studies of unselected/broader patient groups (number of patients in the intervention group ranging from 211 to 2,869) showed no significant difference in survival between physician and paramedical treatment groups. However, one study reported a significant increase in survival rate with physician treatment in a subgroup of patients with acute myocardial infarction and respiratory diseases.