与其他复苏液体相比，院前血液成分对严重创伤性出血患者临床疗效的系统评价方案。
Protocol for a systematic review of the clinical effectiveness of pre-hospital blood components compared to other resuscitative fluids in patients with major traumatic haemorrhage.
作者信息
Dretzke Janine, Smith Iain M, James Robert H, Midwinter Mark J
机构信息
Department of Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical & Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
出版信息
Syst Rev. 2014 Oct 24;3:123. doi: 10.1186/2046-4053-3-123.
BACKGROUND
There is growing interest in the use of blood components for pre-hospital resuscitation of patients with major traumatic haemorrhage. It has been speculated that early resuscitation with blood components may have benefits in terms of treating trauma-induced coagulopathy, which in turn may influence survival. The proposed systematic review will evaluate the evidence on the clinical effectiveness of pre-hospital blood components (red blood cells and/or plasma or whole blood), in both civilian and military settings, compared with other resuscitation strategies in patients with major traumatic haemorrhage.
METHODS/DESIGN: Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. General medical and specialist databases will be searched; the search strategy will combine terms for the population, intervention and setting. Studies will be selected for review if the population includes adult patients with major traumatic haemorrhage who receive blood components in a pre-hospital setting (civilian or military). Systematic reviews, randomised and non-randomised controlled trials and controlled observational studies will be included. Uncontrolled studies will be considered depending on the volume of controlled evidence. Quality assessment will be tailored to different study designs. Both patient related and surrogate outcomes will be considered. Synthesis is likely to be primarily narrative, but meta-analyses and subgroup analyses will be undertaken where clinical and methodological homogeneity exists.
DISCUSSION
Given the increasing use by emergency services of blood components for pre-hospital resuscitation, this is a timely systematic review, which will attempt to clarify the evidence base for this practice. As far as the authors are aware, the proposed systematic review will be the first to address this topic.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42014013794.
背景
对于使用血液成分对严重创伤性出血患者进行院前复苏的关注度日益增加。据推测，早期使用血液成分进行复苏可能在治疗创伤性凝血病方面具有益处，而这反过来可能会影响生存率。拟进行的系统评价将评估在 civilian 和军事环境中，与其他复苏策略相比，院前血液成分（红细胞和/或血浆或全血）对严重创伤性出血患者临床有效性的证据。
方法/设计：将采用旨在最大限度减少偏倚的标准系统评价方法进行研究识别、选择和数据提取。将检索一般医学和专业数据库；检索策略将结合针对人群、干预措施和环境的术语。如果研究人群包括在院前环境（ civilian 或军事）中接受血液成分治疗的成年严重创伤性出血患者，则将选择这些研究进行综述。将纳入系统评价、随机和非随机对照试验以及对照观察性研究。将根据对照证据的数量考虑非对照研究。质量评估将针对不同的研究设计进行调整。将同时考虑与患者相关的结局和替代结局。合成可能主要是叙述性的，但将在存在临床和方法学同质性的情况下进行荟萃分析和亚组分析。
讨论
鉴于紧急服务部门越来越多地使用血液成分进行院前复苏，这是一项及时的系统评价，将试图阐明这种做法的证据基础。据作者所知，拟进行的系统评价将是首个针对该主题的评价。
系统评价注册
PROSPERO CRD42014013794 。
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