title: Disparities in a provision of in-hospital post-arrest interventions for out-of-hospital cardiac arrest (OHCA) in the elderly population-protocol for a systematic review.
abstract: BACKGROUND
  Out-of-hospital cardiac arrest (OHCA) is a significant cause of death in developed countries. The majority of OHCA patients are elderly (≥65 years), and it was documented that they were less likely than younger patients to receive the evidence-based interventions, even though the improvement in survival in the elderly age group was higher than in younger population. Our goal is to investigate any disparity in the provision of post-arrest care for the elderly with OHCA and a sustained return of spontaneous circulation (ROSC).
  
  
  METHODS
  Eight relevant, electronic databases will be systematically searched to identify eligible studies. The searches will be supplemented with gray literature searching of theses, dissertations, and hand searching of pertinent journals. Two independent reviewers will screen the titles and abstracts and select studies for full text analysis using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) method, and both will extract information from the selected studies employing a form based on the Data Extraction Template for Cochrane Reviews. A team of three reviewers will assess the quality of the studies with the modified Downs and Black scale. Statistical methods for evidence synthesis, such as meta-analysis and meta-regression, will be applied to compare and combine the evidence regarding the association between age and intervention provision/utilization, adjusting for a number of significant confounders, such as patient characteristics and co-morbidities and availability of intervention techniques, as well as study specific characteristics. The strength of evidence from the selected studies will be assessed using a modified Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system.
  
  
  CONCLUSIONS
  The findings obtained from this systematic review should inform whether disparity exists in the provision of post-arrest care for the elderly (≥ 65 years old) with OHCA or not. Addressing this problem has a potential to substantially increase the number of > 65-year-old, long-term survivors. The results of our review might also point to the gaps in the published literature that specifically examines disparity in provision of care for this population. This systematic review was designed in accordance with the Preferred Reporting Guidelines for Systematic reviews and Meta-analyses (PRISMA statement), while the protocol follows the Preferred Reporting items for Systematic review and Meta-analysis protocols (PRISMA-P) statement.
  
  
  BACKGROUND
  PROSPERO CRD42015027822.
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.|Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute (TGRI), University Health Network, Toronto General Hospital, Eaton Bldg., 10th Floor, 200 Elizabeth Street, M5G 2C4, Toronto, ON, Canada.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Bielecki
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.|Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute (TGRI), University Health Network, Toronto General Hospital, Eaton Bldg., 10th Floor, 200 Elizabeth Street, M5G 2C4, Toronto, ON, Canada.
authors.forename: Josephine
authors.initials: J
authors.lastname: Wong
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.|Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute (TGRI), University Health Network, Toronto General Hospital, Eaton Bldg., 10th Floor, 200 Elizabeth Street, M5G 2C4, Toronto, ON, Canada.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mitsakakis
authors.affiliation: Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, M5G 1X5, Toronto, ON, Canada.|Department of Pediatrics, University of Toronto, Toronto, ON, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Prakesh S
authors.initials: PS
authors.lastname: Shah
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.|Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute (TGRI), University Health Network, Toronto General Hospital, Eaton Bldg., 10th Floor, 200 Elizabeth Street, M5G 2C4, Toronto, ON, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Murray D
authors.initials: MD
authors.lastname: Krahn
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. valeria.rac@theta.utoronto.ca.|Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute (TGRI), University Health Network, Toronto General Hospital, Eaton Bldg., 10th Floor, 200 Elizabeth Street, M5G 2C4, Toronto, ON, Canada. valeria.rac@theta.utoronto.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. valeria.rac@theta.utoronto.ca.
authors.forename: Valeria E
authors.initials: VE
authors.lastname: Rac
mesh_terms: D000368:Aged; D054625:Healthcare Disparities; D006760:Hospitalization; D006801:Humans; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D012107:Research Design; D000078202:Systematic Reviews as Topic
keywords: Disparity; Elderly; OHCA; Out-of-hospital cardiac arrest; Post-resuscitation interventions