Wuthisuthimethawee Prasit, Sookmee Wainik, Damnoi Siriporn
Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.
Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.
Chin J Traumatol. 2019 Aug;22(4):207-211. doi: 10.1016/j.cjtee.2019.04.003. Epub 2019 May 29.
Trauma is a major health problem in developing countries and worldwide which requires many resources and much time in an emergency department (ED). Although Advanced Trauma Life Support (ATLS) is the gold standard, operator dependence can affect the quality of care. The objective was to identify differences in numbers and time to lifesaving interventions, investigation, ED length of stay, and mortality between an in-house protocol and conventional practice.
This was a single-center prospective non-randomized study for adult trauma patients in the ED. The trauma protocol was developed from the recent ATLS guideline.
Thirty-two and 41 cases were in the in-house protocol group and conventional practice group, respectively. Endotracheal intubation was done more frequently in the in-house protocol group (84% vs. 59%, p = 0.03). Intercostal drainage tube insertion was done faster (6-26 min, median 11 min vs. 15-84 min, median 35 min, p = 0.02) and pre-arrival notification by emergency medical service increased in the in-house protocol group (66% vs. 30%, p = 0.01). Hypothermia in the operating room was found only in the conventional practice group (62% vs. 0, p = 0.007) and a warm blanket was used significantly more often in the in-house protocol group (25% vs. 0, p < 0.001). A directed acyclic graph with multivariate analysis was used to identify confounders. Time to Focused Assessment Sonography in Trauma was significantly shorter in the in-house protocol group (6.5-15.6 min, median 11 min, p = 0.019).
In addition to the ATLS guideline, the trauma protocol could improve trauma care by reduced time to investigation, early notification of the trauma team in pre-hospital situations, reduced incidence of hypothermia in the operating room, and increased use of a warm blanket.
创伤是发展中国家和全球范围内的一个主要健康问题，在急诊科需要大量资源和时间。尽管高级创伤生命支持（ATLS）是金标准，但对操作者的依赖可能会影响护理质量。目的是确定内部方案与传统做法在挽救生命干预的数量和时间、检查、急诊科住院时间以及死亡率方面的差异。
这是一项针对急诊科成年创伤患者的单中心前瞻性非随机研究。创伤方案是根据最新的ATLS指南制定的。
内部方案组和传统做法组分别有32例和41例。内部方案组气管插管的频率更高（84%对59%，p = 0.03）。肋间引流管插入更快（6 - 26分钟，中位数11分钟对15 - 84分钟，中位数35分钟，p = 0.02），内部方案组急诊医疗服务的院前通知增加（66%对30%，p = 0.01）。仅在传统做法组发现手术室体温过低（62%对0，p = 0.007），内部方案组使用暖毯的频率显著更高（25%对0，p < 0.001）。使用带有多变量分析的有向无环图来识别混杂因素。内部方案组创伤重点超声检查的时间显著更短（6.5 - 15.6分钟，中位数11分钟，p = 0.019）。
除了ATLS指南外，创伤方案可通过减少检查时间、在院前情况中提前通知创伤团队、降低手术室体温过低的发生率以及增加暖毯的使用来改善创伤护理。
