成人创伤患者在急性环境下对高级创伤生命支持方案的依从性。
Compliance to advanced trauma life support protocols in adult trauma patients in the acute setting.
机构信息
Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 2D WMC, 8440-112 Street NW, Edmonton, AB T6G 2B7, Canada.
出版信息
World J Emerg Surg. 2013 Oct 2;8(1):39. doi: 10.1186/1749-7922-8-39.
INTRODUCTION
Advanced Trauma Life Support (ATLS) protocols provide a common approach for trauma resuscitations. This was a quality review assessing compliance with ATLS protocols at a Level I trauma center; specifically whether the presence or absence of a trauma team leader (TTL) influenced adherence.
METHODS
This retrospective study was conducted on adult major trauma patients with acute injuries over a one-year period in a Level I Canadian trauma center. Data were collected from the Alberta Trauma Registry, and adherence to ATLS protocols was determined by chart review.
RESULTS
The study identified 508 patients with a mean Injury Severity Score of 24.5 (SD 10.7), mean age 39.7 (SD 17.6), 73.8% were male and 91.9% were involved in blunt trauma. The overall compliance rate was 81.8% for primary survey and 75% for secondary survey. The TTL group compared to non-TTL group was more likely to complete the primary survey (90.9% vs. 81.8%, p = 0.003), and the secondary survey (100% vs. 75%, p = 0.004). The TTL group was more likely than the non-TTL group to complete the following tasks: insertion of two large bore IVs (68.2% vs. 57.7%, p = 0.014), digital rectal exam (64.6% vs. 54.7%, p = 0.023), and head to toe exam (77% vs. 67.1%, p = 0.013). Mean times from emergency department arrival to diagnostic imaging were also significantly shorter in the TTL group compared to the non-TTL group, including times to pelvis xray (mean 68min vs. 107min, p = 0.007), CT chest (mean 133min vs. 172min, p = 0.005), and CT abdomen and pelvis (mean 136min vs. 173min, p = 0.013). Readmission rates were not significantly different between the TTL and non-TTL groups (3.5% vs. 4.5%, p = 0.642).
CONCLUSIONS
While many studies have demonstrated the effectiveness of trauma systems on outcomes, few have explored the direct influence of the TTL on ATLS compliance. This study demonstrated that TTL involvement during resuscitations was associated with improved adherence to ATLS protocols, and increased efficiency (compared to non TTL involvement) to diagnostic imaging. Findings from this study will guide future quality improvement and education for early trauma management.
简介
高级创伤生命支持（ATLS）方案为创伤复苏提供了一种通用方法。本研究为质量评估，旨在评估一级创伤中心是否遵循 ATLS 方案；具体而言，研究是否存在创伤小组组长（TTL）会影响其遵循程度。
方法
本回顾性研究对在加拿大一级创伤中心接受急性创伤的成年重大创伤患者进行，研究时间为一年。数据来自艾伯塔创伤登记处，通过图表审查确定是否符合 ATLS 方案。
结果
研究确定了 508 名患者，平均损伤严重程度评分（ISS）为 24.5（SD 10.7），平均年龄为 39.7（SD 17.6），73.8%为男性，91.9%为钝性创伤。初级检查的总体依从率为 81.8%，二级检查为 75%。与非 TTL 组相比，TTL 组更有可能完成初级检查（90.9%比 81.8%，p=0.003）和二级检查（100%比 75%，p=0.004）。TTL 组比非 TTL 组更有可能完成以下任务：插入两个大口径静脉输液管（68.2%比 57.7%，p=0.014）、直肠指检（64.6%比 54.7%，p=0.023）和从头到脚检查（77%比 67.1%，p=0.013）。TTL 组与非 TTL 组相比，从急诊科到达诊断成像的平均时间也显著缩短，包括骨盆 X 射线（平均 68 分钟比 107 分钟，p=0.007）、胸部 CT（平均 133 分钟比 172 分钟，p=0.005）和腹部和骨盆 CT（平均 136 分钟比 173 分钟，p=0.013）。TTL 组和非 TTL 组的再入院率无显著差异（3.5%比 4.5%，p=0.642）。
结论
虽然许多研究已经证明了创伤系统对结局的有效性，但很少有研究探讨 TTL 对 ATLS 依从性的直接影响。本研究表明，复苏过程中 TTL 的参与与 ATLS 方案的依从性提高有关，并提高了诊断成像的效率（与非 TTL 参与相比）。本研究的结果将指导未来创伤早期管理的质量改进和教育。
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