肺栓塞反应团队（PERT）建立后治疗和结局的变化：10 年分析。
Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis.
机构信息
Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA.
Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
J Thromb Thrombolysis. 2019 Jan;47(1):31-40. doi: 10.1007/s11239-018-1737-8.
Multidisciplinary pulmonary embolism response teams (PERTs) are being implemented to improve care of patients with life-threatening PE. We sought to determine how the creation of PERT affects treatment and outcomes of patients with serious PE. A pre- and post-intervention study was performed using an interrupted time series design, to compare patients with PE before (2006-2012) and after (2012-2016) implementation of PERT at a university hospital. T-tests, Chi square tests and logistic regression were used to compare outcomes, and multivariable regression were used to adjust for differences in PE severity. Two-sided p-value < 0.05 was considered significant. For the interrupted time-series analysis, data was divided into mutually exclusive 6-month time periods (11 pre- and 7 post-PERT). To examine changes in treatment and outcomes associated with PERT, slopes and change points were compared pre- and post-PERT. Two-hundred and twelve pre-PERT and 228 post-PERT patients were analyzed. Patient demographics were generally similar, though pre-PERT, PE were more likely to be low-risk (37% vs. 19%) while post-PERT, PE were more likely to be submassive (32% vs. 49%). More patients underwent catheter directed therapy (1% vs. 14%, p = < 0.0001) or any advanced therapy (19 [9%] vs. 44 [19%], p = 0.002) post PERT. Interrupted time series analysis demonstrated that this increase was sudden and coincident with implementation of PERT, and most noticeable among patients with submassive PE. There were no differences in major bleeding or mortality pre- and post-PERT. While the use of advanced therapies, particularly catheter-directed therapies, increased after creation of PERT, especially among patients with submassive PE, there was no apparent increase in bleeding.
多学科肺栓塞反应团队（PERT）的实施旨在改善危及生命的 PE 患者的护理。我们旨在确定创建 PERT 如何影响严重 PE 患者的治疗和结局。使用中断时间序列设计进行了一项干预前后研究，以比较大学医院实施 PERT 前后（2006-2012 年和 2012-2016 年）的 PE 患者。使用 t 检验、卡方检验和逻辑回归比较结局，并使用多变量回归调整 PE 严重程度的差异。双侧 p 值 < 0.05 被认为具有统计学意义。对于中断时间序列分析，数据分为相互排斥的 6 个月时间期（11 个 PERT 前和 7 个 PERT 后）。为了检查 PERT 相关的治疗和结局变化，比较了 PERT 前后的斜率和变化点。分析了 212 例 PERT 前和 228 例 PERT 后患者。患者的人口统计学特征总体相似，尽管 PERT 前的 PE 更可能是低危（37%比 19%），而 PERT 后的 PE 更可能是亚大块（32%比 49%）。更多的患者接受了导管定向治疗（1%比 14%，p < 0.0001）或任何高级治疗（19 [9%]比 44 [19%]，p = 0.002）。中断时间序列分析表明，这种增加是突然的，与 PERT 的实施同时发生，在亚大块 PE 患者中最为明显。PERT 前后主要出血或死亡率无差异。虽然 PERT 后高级治疗的使用，特别是导管定向治疗的使用增加，但在亚大块 PE 患者中，出血似乎没有明显增加。
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