Western Health, The Alfred Hospital and Monash University, Australia.
Emerg Med Australas. 2010 Dec;22(6):556-64. doi: 10.1111/j.1742-6723.2010.01355.x.
Clinical practice guidelines for haemodynamically unstable patients with pelvic fractures were initiated in February 2005 at our level 1 trauma centre. The purpose of the present study was to evaluate guideline adherence and outcome of guideline performance. In a retrospective clinical study all patients admitted with a pelvic fracture from August 2003 to March 2007 were identified from a prospective trauma registry database. Medical records of all patients were reviewed. Patients with pelvic fractures associated with haemodynamic instability were included. Patients were divided into two groups: preguideline and postguideline. The two groups were compared. Main outcome measurements were 24 h fluid requirement, total blood transfusion, length of stay in ICU and hospital, and mortality rate. Of the 210 patients with pelvic fractures, 32 patients met the inclusion criteria. Preguideline group consisted of 13 and postguideline group 19 patients. Non-invasive pelvic stabilization was applied significantly more postguideline (92.3% vs 33.3%, P= 0.004). Focused abdominal sonography for trauma and pelvic angiography/embolization have been used significantly more in the postguideline group (5 vs 14, P= 0.046 and 0 vs 6, P= 0.025, respectively). There was no significant difference in 24 h fluid requirement, total blood transfusion, length of stay in ICU and hospital, and mortality rate between the two groups. The introduction of guidelines has influenced the approach to haemodynamically unstable patients with pelvic fractures. Multiple factors can potentially influence the strict adherence to the guideline. Care provided can still be improved by addressing the challenges in guideline performance.
2005 年 2 月，我们在 1 级创伤中心启动了针对血流动力学不稳定骨盆骨折患者的临床实践指南。本研究旨在评估指南的依从性和指南执行效果。在一项回顾性临床研究中，我们从前瞻性创伤登记数据库中确定了 2003 年 8 月至 2007 年 3 月期间因骨盆骨折而入院的所有患者。我们对所有患者的病历进行了审查。纳入合并血流动力学不稳定的骨盆骨折患者。患者分为两组：指南前组和指南后组。对两组进行比较。主要观察指标为 24 小时液体需求、总输血量、ICU 和住院时间及死亡率。在 210 例骨盆骨折患者中，有 32 例符合纳入标准。指南前组 13 例，指南后组 19 例。指南后组更广泛地应用了非侵入性骨盆稳定术（92.3% vs 33.3%，P=0.004）。创伤焦点超声检查和骨盆血管造影/栓塞术在后组中的应用也显著增多（5 例 vs 14 例，P=0.046 和 0 例 vs 6 例，P=0.025）。两组间 24 小时液体需求、总输血量、ICU 和住院时间及死亡率无显著差异。指南的引入影响了对血流动力学不稳定骨盆骨折患者的治疗方法。多个因素可能会对严格遵守指南产生影响。通过解决指南执行中的挑战，仍可改善护理。
