创伤三级调查：创伤服务医务人员和创伤护士检出的漏诊损伤发生率相似。

Trauma Tertiary Survey: Trauma Service Medical Officers and Trauma Nurses Detect Similar Rates of Missed Injuries.

机构信息

Trauma Service (Mss Williamson and Grant and Mr Handy) and Jamieson Trauma Institute (Mss Williamson and Warren and Mr Handy), Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia; and Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia (Ms Williamson).

出版信息

J Trauma Nurs. 2021;28(3):166-172. doi: 10.1097/JTN.0000000000000578.

DOI:10.1097/JTN.0000000000000578

PMID:33949352

Abstract

BACKGROUND

Trauma tertiary surveys (TTSs) can improve patient outcomes by identifying missed injuries following initial trauma reception and resuscitation. Most TTSs are conducted by medical officers despite the multidisciplinary team approach of modern trauma care.

OBJECTIVE

The study aim was to assess the accuracy of detecting missed injuries when the TTS was performed by specialist trauma nursing staff, rather than trauma service medical officers (TSMOs).

METHODS

A prospective, convenience sample of adult trauma patients admitted to a tertiary trauma center and attended by the trauma service between October 2015 and August 2018 was obtained. For this sample, a TTS was completed by both the TSMO and the trauma nurse (TN). The number of radiological investigations ordered and missed injuries identified were compared between the two clinicians. Additional injuries were graded using the Clavien-Dindo system.

RESULTS

The study sample consisted of 165 patients with a dual TTS, for which at least one team member requested 35 additional radiological investigations. There was fair agreement (κ = 0.36) between the TN and the TSMO in requesting additional radiological investigations. Ten missed injuries were identified by TN-initiated review (n = 24), and 4 missed injuries were identified by TSMO-initiated review (n = 21). Injuries identified following TTSs ranged in severity grading from 0 to 3.

CONCLUSIONS

Performance of the TN on the TTS in the identification of missed injuries is similar to that of the TSMO. Trauma nurses use an appropriate and rationalized approach to ordering additional radiological investigations and contribute a valuable addition to trauma patient care.

摘要

背景

创伤三级检查（TTS）可以通过识别初次创伤接收和复苏后遗漏的损伤来改善患者的预后。尽管现代创伤护理采用多学科团队方法，但大多数 TTS 都是由医疗官员进行的。

目的

本研究旨在评估由专科创伤护理人员而不是创伤服务医疗官员（TSMO）进行 TTS 时检测遗漏损伤的准确性。

方法

获得了 2015 年 10 月至 2018 年 8 月期间在三级创伤中心接受创伤服务治疗的成年创伤患者的前瞻性便利样本。对于该样本，TSMO 和创伤护士（TN）都完成了 TTS。比较了两名临床医生之间所开放射学检查数量和发现的遗漏损伤。使用 Clavien-Dindo 系统对额外的损伤进行分级。

结果

研究样本包括 165 名接受双重 TTS 的患者，至少有一名团队成员要求进行 35 项额外的放射学检查。TN 和 TSMO 在要求额外放射学检查方面具有适度的一致性（κ=0.36）。TN 发起的审查发现了 10 处遗漏损伤（n=24），而 TSMO 发起的审查发现了 4 处遗漏损伤（n=21）。TTS 后发现的损伤严重程度分级从 0 到 3 不等。