Review article: Antiemetics in the pre-hospital setting: A systematic review of efficacy and safety.

Antiemetics are medications that are frequently used in the pre-hospital setting. However, recent evidence indicates that antiemetics are ineffective in reducing undifferentiated nausea scores and vomiting rates. The aim of this study is to evaluate the efficacy and safety of antiemetics administered in the pre-hospital setting. This is a systematic review employing PRISMA guidelines of seven studies selected that included randomised controlled trials and prospective studies, investigating the use of antiemetics in the pre-hospital setting. Nausea scores, vomiting rates and rates of adverse effects along with other variables were summarised. Searches of PubMed, MEDLINE, CINAHL and InformIT yielded seven relevant full text articles. Trials that investigated the efficacy of all antiemetics in the pre-hospital setting were included in the search results. Overall, it was found that antiemetics were effective in reducing nausea and vomiting rates in the pre-hospital setting on initial evaluation. The antiemetics included in the studies were associated with insignificant or self-limiting side-effects. However, after further examination, the reliability of the preliminary results can be questioned because of the poor quality of all the studies reviewed. There is insufficient evidence to establish the efficacy of antiemetics in the pre-hospital setting despite their safety. Further rigorous studies, preferably randomised and double blinded control trials are required to establish the efficacy of antiemetics in the pre-hospital setting. Consequently, antiemetics should be used more selectively and reserved for severe nausea and intractable vomiting in the pre-hospital setting. PROSPERO registration number: CRD42016044090.