多学科围产期应急响应团队的实施可提高明确的产科评估和胎儿评估的时间。
Implementation of a multidisciplinary perinatal emergency response team improves time to definitive obstetrical evaluation and fetal assessment.
机构信息
From the Division of Trauma (J.A.S., A.S., N.P., B.P., D.Y.K.), Harbor-UCLA Medical Center; Los Angeles BioMedical Research Institute (J.A.S., R.E., A.M., B.P., D.Y.K.); Division of Obstetrics and Gynecology (R.E.), and Division of General Surgery (A.M.), Harbor-UCLA Medical Center, Torrance, California.
出版信息
J Trauma Acute Care Surg. 2020 May;88(5):615-618. doi: 10.1097/TA.0000000000002615.
BACKGROUND
Trauma is the leading cause of nonobstetric death during pregnancy and is associated with an increased risk of maternal and fetal mortality. In an effort to improve the delivery of care to pregnant trauma patients, we developed an institutional multidisciplinary quality initiative designed to improve response times of nontrauma specialists and ensure immediate availability of resources. We hypothesized that implementation of a perinatal emergency response team (PERT) would improve time to patient and fetal evaluation and monitoring by the obstetrics (OB) team and improve both maternal and fetal outcomes.
METHODS
We performed a 6-year (2012-2018) retrospective cohort analysis of consecutive pregnant trauma patients presenting to our university-affiliated, level I trauma center. Patients in the pre-PERT cohort (before April 2015) were compared with a post-PERT cohort. Variables analyzed included patient demographics, mechanism of injury, Injury Severity Score, and level of trauma activation. The main outcome measure was time to OB evaluation. Secondary outcomes included time to cardiotocometry, and mortality.
RESULTS
Of 92 pregnant trauma patients, there were 50 patients (54.3%) in the pre-PERT cohort and 42 (45.7%) in the post-PERT group. Blunt injuries predominated (98.9%), with the most common mechanism being motor vehicle collisions (76.1%), followed by assaults (13%) and falls (6.5%). The mean time to obstetrical evaluation was 44 minutes in the pre-PERT cohort compared with 14 minutes in the post-PERT cohort (p = 0.001). There was a significant decrease in level I (highest acuity) trauma activations pre-PERT and post-PERT (46% vs. 21%, p = 0.01), and the time to cardiotocography was significantly decreased post-PERT implementation (72 vs. .37 min, p = 0.01) CONCLUSION: Implementation of a multidisciplinary PERT improves time to evaluation by the OB team and time to cardiotocometry in the pregnant trauma patient.
LEVEL OF EVIDENCE
Retrospective review, level IV.
背景
创伤是妊娠期间非产科死亡的主要原因，与母婴死亡率增加有关。为了改善对妊娠创伤患者的护理，我们制定了一项机构多学科质量倡议，旨在提高非创伤专家的反应时间，并确保资源的即时可用性。我们假设实施围产期应急小组（PERT）将改善产科（OB）团队对患者和胎儿的评估和监测时间，并改善母婴结局。
方法
我们对 2012 年至 2018 年连续到我们大学附属一级创伤中心就诊的妊娠创伤患者进行了 6 年的回顾性队列分析。将 PRE-PERT 队列（2015 年 4 月前）中的患者与 POST-PERT 队列进行比较。分析的变量包括患者人口统计学、损伤机制、损伤严重程度评分和创伤激活水平。主要观察指标是 OB 评估时间。次要结果包括胎儿心监护时间和死亡率。
结果
在 92 例妊娠创伤患者中，PRE-PERT 队列有 50 例（54.3%），POST-PERT 队列有 42 例（45.7%）。钝性损伤为主（98.9%），最常见的机制是机动车碰撞（76.1%），其次是攻击（13%）和跌倒（6.5%）。PRE-PERT 队列的产科评估时间平均为 44 分钟，而 POST-PERT 队列为 14 分钟（p = 0.001）。PRE-PERT 和 POST-PERT 的一级（最高严重程度）创伤激活显著减少（46%比 21%，p = 0.01），POST-PERT 实施后胎儿心监护时间显著减少（72 比 0.37 分钟，p = 0.01）。
结论
实施多学科 PERT 可提高 OB 团队对妊娠创伤患者的评估时间和胎儿心监护时间。
证据水平
回顾性研究，四级。
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