采用预计用力肺活量百分比的临床实践指南可改善肋骨骨折患者的资源分配。
A clinical practice guideline using percentage of predicted forced vital capacity improves resource allocation for rib fracture patients.
机构信息
From the Department of Trauma and Acute Care Surgery (J.D.B., A.D.K., T.J.S.), University of Colorado Health Memorial Hospital, Colorado Springs; Department of Surgery (J.D.B., A.D.K., T.J.S.), University of Colorado, Aurora; and Department of Pharmacy (L.P.C., A.A.D., E.W.B.), University of Colorado Health Memorial Hospital, Colorado Springs, Colorado.
出版信息
J Trauma Acute Care Surg. 2021 May 1;90(5):769-775. doi: 10.1097/TA.0000000000003083.
BACKGROUND
Predicting rib fracture patients that will require higher-level care is a challenge during patient triage. Percentage of predicted forced vital capacity (FVC%) incorporates patient-specific factors to customize the measurements to each patient. A single institution transitioned from a clinical practice guideline (CPG) using absolute forced vital capacity (FVC) to one using FVC% to improve triage of rib fracture patients. This study compares the outcomes of patients before and after the CPG change.
METHODS
A review of rib fracture patients was performed over a 3-year retrospective period (RETRO) and 1-year prospective period (PRO). RETRO patients were triaged by absolute FVC. Percentage of predicted FVC was used to triage PRO patients. Demographics, mechanism, Injury Severity Score, chest Abbreviated Injury Scale score, number of rib fractures, tube thoracostomy, intubation, admission to intensive care unit (ICU), transfer to ICU, hospital length of stay (LOS), ICU LOS, and mortality data were compared. A multivariable model was constructed to perform adjusted analysis for LOS.
RESULTS
There were 588 patients eligible for the study, with 269 RETRO and 319 PRO patients. No significant differences in age, gender, or injury details were identified. Fewer tube thoracostomy were performed in PRO patients. Rates of intubation, admission to ICU, and mortality were similar. The PRO cohort had fewer ICU transfers and shorter LOS and ICU LOS. Multivariable logistic regression identified a 78% reduction in odds of ICU transfer among PRO patients. Adjusted analysis with multiple linear regression showed LOS was decreased 1.28 days by being a PRO patient in the study (B = -1.44; p < 0.001) with R2 = 0.198.
CONCLUSION
Percentage of predicted FVC better stratified rib fracture patients leading to a decrease in transfers to the ICU, ICU LOS, and hospital LOS. By incorporating patient-specific factors into the triage decision, the new CPG optimized triage and decreased resource utilization over the study period.
LEVEL OF EVIDENCE
Therapeutic/Care Management. Trauma, Rib, Triage, level IV.
背景
在患者分诊过程中，预测需要更高层次护理的肋骨骨折患者是一项挑战。预计用力肺活量百分比（FVC%）将患者的具体因素纳入其中，以根据每位患者的情况定制测量结果。一家机构从使用绝对用力肺活量（FVC）的临床实践指南（CPG）过渡到使用 FVC%，以改善肋骨骨折患者的分诊。本研究比较了 CPG 变更前后患者的结果。
方法
对 3 年回顾期（RETRO）和 1 年前瞻性期（PRO）的肋骨骨折患者进行了回顾。RETRO 患者的 FVC 采用绝对 FVC 进行分诊。PRO 患者的 FVC%用于分诊。比较了人口统计学、机制、损伤严重程度评分、胸部简明损伤评分、肋骨骨折数量、胸腔引流管、插管、入住重症监护病房（ICU）、转入 ICU、住院时间（LOS）、ICU LOS 和死亡率数据。构建多变量模型对 LOS 进行调整分析。
结果
共有 588 名患者符合研究条件，其中 269 名 RETRO 患者和 319 名 PRO 患者。年龄、性别或损伤细节无显著差异。PRO 患者的胸腔引流管数量较少。插管、入住 ICU 和死亡率相似。PRO 组 ICU 转科次数较少， LOS 和 ICU LOS 较短。多变量逻辑回归确定 PRO 患者 ICU 转科的可能性降低了 78%。调整后的多元线性回归显示，作为研究中的 PRO 患者， LOS 减少了 1.28 天（B=-1.44；p<0.001），R2=0.198。
结论
预计 FVC%更好地对肋骨骨折患者进行分层，从而减少转入 ICU、ICU LOS 和住院 LOS 的患者数量。通过将患者特定因素纳入分诊决策，新的 CPG 在研究期间优化了分诊并减少了资源利用。
证据水平
治疗/护理管理。创伤，肋骨，分类，IV 级。
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