65 岁及以上钝性胸部损伤患者干预的效果：患者和卫生服务结局。
Effect of an intervention for patients 65 years and older with blunt chest injury: Patient and health service outcomes.
机构信息
Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia; Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong NSW, Australia; Illawarra Health and Medical Research Institute, Building 32 University of Wollongong, Northfields Avenue, Wollongong NSW, Australia.
Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia.
出版信息
Injury. 2022 Sep;53(9):2939-2946. doi: 10.1016/j.injury.2022.04.024. Epub 2022 May 25.
INTRODUCTION
Blunt chest injury in older adults, aged 65 years and older, leads to significant morbidity and mortality. The aim of this study was to evaluate the effect of a multidisciplinary chest injury care bundle (ChIP) on patient and health service outcomes in older adults with blunt chest injury.
METHODS
ChIP comprised multidimensional implementation guidance in three key pillars of care for blunt chest injury: respiratory support, analgesia, and complication prevention. Implementation was guided using the Behaviour Change Wheel. This proof-of-concept controlled pre- and post-test study with two intervention and two control sites in Australia was conducted from July 2015 to June 2019. The primary outcomes were non-invasive ventilation (NIV) use, unplanned Intensive Care Unit (ICU) admissions, and in-hospital mortality. Secondary outcomes were health service and costing outcomes.
RESULTS
There were 1122 patients included in the analysis, with 673 at intervention sites (331 pre-test and 342 post-test) and 449 at control sites (256 pre-test and 193 post-test). ChIP was associated with unplanned ICU admissions and in NIV use with a reduction of the odds in the post vs the pre periods in the intervention sites when compared to the controls (ratio of OR=0.13, 95%CI=0.03-0.55) and (ratio of OR=0.14, 95%CI=0.02-0.98) respectively. There was no significant change in mortality. Implementing ChIP was also associated with health service team reviews with an increased odds in the post vs pre periods in the intervention sites in comparison to the controls for surgical review (ratio of OR =6.93, 95%CI=4.70-10.28), ICU doctor (ratio of OR =5.06, 95%CI=2.26-9.25), ICU liaison (ratio of OR =14.14, 95%CI=3.15-63.31), and pain (ratio of OR =5.59, 95%CI=3.25-9.29). ChIP was also related to incentive spirometry (ratio of OR=6.35, 95%CI= 3.15-12.82) and overall costs (ratio of mean ratio=1.34, 95%CI=1.09-1.66) with a higher ratio for intervention sites.
CONCLUSION
Implementation of ChIP using the Behaviour Change Wheel was associated with reduced unplanned ICU admissions and NIV use and improved health care delivery.
TRIAL REGISTRATION
ANZCTR: ACTRN12618001548224, approved 17/09/2018.
简介
老年人（65 岁及以上）钝性胸部损伤会导致显著的发病率和死亡率。本研究旨在评估多学科胸部损伤护理包（ChIP）对老年钝性胸部损伤患者的患者和医疗服务结果的影响。
方法
ChIP 包括三个关键护理支柱的多维实施指南：呼吸支持、镇痛和并发症预防。实施采用行为改变车轮进行指导。这项在澳大利亚的两个干预和两个对照地点进行的概念验证性、前后测试研究于 2015 年 7 月至 2019 年 6 月进行。主要结局是无创通气（NIV）使用、计划外重症监护病房（ICU）入院和院内死亡率。次要结局是医疗服务和成本结果。
结果
共有 1122 名患者纳入分析，干预组 673 例（331 例前测和 342 例后测），对照组 449 例（256 例前测和 193 例后测）。与对照组相比，ChIP 与计划外 ICU 入院和 NIV 使用相关，干预组后测期与前测期相比，比值比（OR）分别为 0.13（95%CI=0.03-0.55）和 0.14（95%CI=0.02-0.98）。死亡率无显著变化。与对照组相比，ChIP 的实施还与健康服务团队审查相关，干预组后测期与前测期相比，外科审查（OR=6.93，95%CI=4.70-10.28）、ICU 医生（OR=5.06，95%CI=2.26-9.25）、ICU 联络（OR=14.14，95%CI=3.15-63.31）和疼痛（OR=5.59，95%CI=3.25-9.29）的可能性增加。ChIP 还与激励式肺活量计（OR=6.35，95%CI=3.15-12.82）和总体成本（平均比值比=1.34，95%CI=1.09-1.66）相关，干预组的比值更高。
结论
采用行为改变车轮实施 ChIP 与减少计划外 ICU 入院和 NIV 使用以及改善医疗服务提供有关。
试验注册
澳大利亚新西兰临床试验注册中心：ACTRN12618001548224，批准日期 2018 年 9 月 17 日。
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