Hibbert Peter D, Molloy Charlotte J, Hooper Tamara D, Wiles Louise K, Runciman William B, Lachman Peter, Muething Stephen E, Braithwaite Jeffrey
Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, New South Wales 2109, Australia.
Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001, Australia.
Int J Qual Health Care. 2016 Dec 1;28(6):640-649. doi: 10.1093/intqhc/mzw115.
This study describes the use of, and modifications and additions made to, the Global Trigger Tool (GTT) since its first release in 2003, and summarizes its findings with respect to counting and characterizing adverse events (AEs).
Peer-reviewed literature up to 31st December 2014.
A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
Two authors extracted and compiled the demographics, methodologies and results of the selected studies.
Of the 48 studies meeting the eligibility criteria, 44 collected data from inpatient medical records and four from general practice records. Studies were undertaken in 16 countries. Over half did not follow the standard GTT protocol regarding the number of reviewers used. 'Acts of omission' were included in one quarter of studies. Incident reporting detected between 2% and 8% of AEs that were detected with the GTT. Rates of AEs varied in general inpatient studies between 7% and 40%. Infections, problems with surgical procedures and medication were the most common incident types.
The GTT is a flexible tool used in a range of settings with varied applications. Substantial differences in AE rates were evident across studies, most likely associated with methodological differences and disparate reviewer interpretations. AE rates should not be compared between institutions or studies. Recommendations include adding 'omission' AEs, using preventability scores for priority setting, and re-framing the GTT's purpose to understand and characterize AEs rather than just counting them.
本研究描述了全球触发工具（GTT）自2003年首次发布以来的使用情况、所做的修改和补充，并总结了其在不良事件（AE）计数和特征描述方面的研究结果。
截至2014年12月31日的同行评审文献。
根据系统评价和Meta分析的首选报告项目声明进行系统评价。
两位作者提取并汇总了所选研究的人口统计学、方法和结果。
在符合纳入标准的48项研究中，44项从住院病历中收集数据，4项从全科医疗记录中收集数据。研究在16个国家开展。超过半数的研究未遵循关于评审员数量的标准GTT方案。四分之一的研究纳入了“不作为行为”。事件报告检测到的AE占GTT检测到的AE的2%至8%。普通住院研究中的AE发生率在7%至40%之间。感染、手术操作问题和用药问题是最常见的事件类型。
GTT是一种灵活的工具，在一系列环境中有不同的应用。各研究之间AE发生率存在显著差异，很可能与方法学差异和评审员的不同解读有关。不应在不同机构或研究之间比较AE发生率。建议包括增加“不作为”AE、使用可预防性评分来确定优先级，以及重新界定GTT的目的，以了解和描述AE，而不仅仅是对其进行计数。
