改善钝性胸部创伤结局：引入 PIC 评分。
Improving Blunt Chest Wall Injury Outcomes: Introducing the PIC Score.
机构信息
Departments of Trauma and Critical Care Surgery (Dr Terry) and Trauma Services (Ms Shoff and Mr Sharrah), WellSpan Health-York Hospital, York, Pennsylvania.
出版信息
J Trauma Nurs. 2021;28(6):386-394. doi: 10.1097/JTN.0000000000000618.
BACKGROUND
To improve care for nonintubated blunt chest wall injury patients, our Level I trauma center developed a treatment protocol and a pulmonary evaluation tool named "PIC Protocol" and "PIC Score," emphasizing continual assessment of pain, incentive spirometry, and cough ability.
OBJECTIVE
The primary objective was to reduce unplanned intensive care unit admissions for blunt chest wall injury patients using the PIC Protocol and the PIC Score. Additional outcomes included intensive care unit length of stay, ventilator days, length of hospital stay, inhospital mortality, and discharge destination.
METHODS
This was a retrospective cohort study comparing outcomes of rib fracture patients treated at our facility 2 years prior to (control group) and 2 years following PIC Protocol use (PIC group). The protocol included admission screening, a power plan order set, the PIC Score patient assessment tool, in-room communication board, and patient education brochure. Outcomes were compared using independent-samples t tests for continuous variables and Pearson's χ2 for categorical variables with α set to p < .05.
RESULTS
There were 1,036 patients in the study (control = 501; PIC = 535). Demographics and injury severity were similar between groups. Unanticipated escalations of care for acute pulmonary distress were reduced from 3% (15/501) in the control group to 0.37% (2/535) in the PIC group and were predicted by a preceding fall in the PIC Score of 3 points over the previous 8-hr shift, marking pulmonary decline by an acutely falling PIC Score.
CONCLUSIONS
The PIC Protocol and the PIC Score are easy-to-use, cost-effective tools for guiding care of blunt chest wall injury patients.
背景
为了改善非插管性钝性胸壁损伤患者的护理，我们的一级创伤中心制定了治疗方案和肺部评估工具，分别命名为“PIC 方案”和“PIC 评分”，强调持续评估疼痛、激励式肺活量计和咳嗽能力。
目的
使用 PIC 方案和 PIC 评分，降低非插管性钝性胸壁损伤患者计划外转入重症监护病房的比例。其他结果还包括重症监护病房的住院时间、呼吸机使用天数、住院时间、院内死亡率和出院去向。
方法
这是一项回顾性队列研究，比较了我们医院在使用 PIC 方案前 2 年（对照组）和使用 PIC 方案后 2 年（PIC 组）收治的肋骨骨折患者的结局。该方案包括入院筛查、动力计划医嘱集、PIC 评分患者评估工具、病房内沟通板和患者教育手册。使用独立样本 t 检验比较连续变量，使用 Pearson χ²检验比较分类变量，α 值设定为 p<0.05。
结果
研究共纳入 1036 例患者（对照组 501 例，PIC 组 535 例）。两组患者的人口统计学特征和损伤严重程度相似。急性肺部窘迫的意外升级治疗比例从对照组的 3%（15/501）降至 PIC 组的 0.37%（2/535），并且可通过 PIC 评分在前 8 小时内下降 3 分来预测，这标志着 PIC 评分的急性下降预示着肺部功能的下降。
结论
PIC 方案和 PIC 评分是指导钝性胸壁损伤患者护理的简单、经济有效的工具。
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