多学科临床路径可降低高危创伤患者肋骨骨折相关的感染发病率和死亡率。

A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients.

作者信息

Todd S Rob, McNally Michael M, Holcomb John B, Kozar Rosemary A, Kao Lillian S, Gonzalez Ernest A, Cocanour Christine S, Vercruysse Gary A, Lygas Marjorie H, Brasseaux Bobbie K, Moore Frederick A

机构信息

Department of Surgery, The Methodist Hospital, 6550 Fannin Street, Smith Tower 1661, Houston, TX 77030, USA.

出版信息

Am J Surg. 2006 Dec;192(6):806-11. doi: 10.1016/j.amjsurg.2006.08.048.

DOI:10.1016/j.amjsurg.2006.08.048

PMID:17161098

Abstract

BACKGROUND

We initiated a multidisciplinary clinical pathway targeting patients greater than 45 years of age with more than 4 rib fractures. The purpose of the current study was to evaluate the effect of this pathway on infectious morbidity and mortality.

METHODS

This was a prospective cohort study. Data evaluated included patient demographics, injury characteristics, pain management details, lengths of stay, morbidity, and mortality. Univariate and multivariate analyses were performed using a significance level of P < .05.

RESULTS

When adjusting for age, injury severity score, and number of rib fractures, the clinical pathway was associated with decreased intensive care unit length of stay by 2.4 days (95% confidence interval [CI] -4.3, -0.52 days, P = .01) hospital length of stay by 3.7 days (95% CI -7.1, -0.42 days, P = .02), pneumonias (odds ratio [OR] 0.12, 95% CI 0.04 to 0.34, P < .001), and mortality (OR 0.37, 95% CI 0.13 to 1.03, P = .06).

CONCLUSIONS

Implementation of a rib fracture multidisciplinary clinical pathway decreased mechanical ventilator-dependent days, lengths of stay, infectious morbidity, and mortality.

摘要

背景

我们启动了一项针对45岁以上、肋骨骨折超过4根患者的多学科临床路径。本研究的目的是评估该路径对感染性发病率和死亡率的影响。

方法

这是一项前瞻性队列研究。评估的数据包括患者人口统计学、损伤特征、疼痛管理细节、住院时间、发病率和死亡率。使用显著性水平P <.05进行单变量和多变量分析。

结果

在调整年龄、损伤严重程度评分和肋骨骨折数量后，临床路径与重症监护病房住院时间减少2.4天（95%置信区间[CI] -4.3，-0.52天，P =.01）、医院住院时间减少3.7天（95% CI -7.1，-0.42天，P =.02）、肺炎（比值比[OR] 0.12，95% CI 0.04至0.34，P <.001）和死亡率（OR 0.37，95% CI 0.13至1.03，P =.06）相关。