Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
J Am Geriatr Soc. 2009 Nov;57(11):2046-54. doi: 10.1111/j.1532-5415.2009.02492.x. Epub 2009 Sep 28.
To assess the association between use of clinical pathways for hip fracture and changes in the rates of five inpatient complications and short-term mortality.
Meta-analysis of published studies examining clinical pathways for hip fracture, identified through systematic searches of electronic databases (MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials) and hand searches of selected article bibliographies.
Observational and interventional studies of clinical pathways for hip fracture examining rates of deep venous thrombosis, pressure ulcer, surgical site infection, urinary tract infection, pneumonia, and inpatient or 30-day mortality.
Two reviewers.
Reviewers independently assessed eligibility and quality of studies and extracted data for outcomes of interest.
Meta-analysis of nine studies (4,637 patients) demonstrated lower odds of deep venous thrombosis (odds ratio (OR)=0.33, 95% CI=0.14-0.75), pressure ulcer (OR=0.48, 95% CI=0.30-0.75), surgical site infection (OR=0.48, 95% CI=0.25-0.89), and urinary tract infection (OR=0.71, 95% CI=0.52-0.98) in patients managed according to clinical pathways than in those receiving usual care. Statistically significant differences were not observed in the odds of pneumonia (OR=1.01, 95% CI=0.67-1.53) or in a combined outcome of in-hospital or 30-day mortality (OR=0.86, 95% CI=0.66-1.13).
An association was observed between clinical pathway use and lower odds of four common complications of hospitalization after hip fracture; only a small, statistically insignificant association was observed between pathway use and changes in short-term mortality, suggesting that assessments of hospital quality based on short-term mortality may not reflect important improvements in patient outcomes that hospitals may achieve using clinical pathways.
评估髋部骨折临床路径的应用与五种住院并发症发生率和短期死亡率变化之间的关系。
通过对电子数据库（MEDLINE、EMBASE、CINAHL 和 Cochrane 对照试验中心注册库）进行系统检索，并对选定文章的参考文献进行手工检索，对髋部骨折临床路径的研究进行了已发表的研究的荟萃分析。
观察性和干预性研究髋部骨折临床路径，评估深静脉血栓形成、压疮、手术部位感染、尿路感染、肺炎以及住院或 30 天死亡率的发生率。
两位评审员。
评审员独立评估研究的合格性和质量，并提取感兴趣结局的数据。
对 9 项研究（4637 例患者）的荟萃分析显示，根据临床路径治疗的患者发生深静脉血栓形成（优势比（OR）=0.33，95%置信区间（CI）=0.14-0.75）、压疮（OR）=0.48，95%CI=0.30-0.75）、手术部位感染（OR）=0.48，95%CI=0.25-0.89）和尿路感染（OR）=0.71，95%CI=0.52-0.98）的可能性降低。在肺炎（OR=1.01，95%CI=0.67-1.53）或住院或 30 天死亡率（OR=0.86，95%CI=0.66-1.13）的综合结局方面，未观察到统计学意义上的差异。
髋部骨折后住院期间常见并发症的发生几率与临床路径的应用之间存在关联；临床路径的应用与短期死亡率的变化之间仅存在较小的、统计学上无显著性的关联，这表明基于短期死亡率的医院质量评估可能无法反映医院通过临床路径可能实现的对患者结局的重要改善。
