Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
West J Emerg Med. 2022 Apr 13;23(3):334-344. doi: 10.5811/westjem.2022.1.53674.
Trauma exposure is a highly prevalent experience for patients and clinicians in emergency medicine (EM). Trauma-informed care (TIC) is an effective framework to mitigate the negative health impacts of trauma. This systematic review synthesizes the range of TIC interventions in EM, with a focus on patient and clinician outcomes, and identifies gaps in the current research on implementing TIC.
The study was registered with PROSPERO (CRD42020205182). We systematically searched peer-reviewed journals and abstracts in the PubMed, EMBASE (Elsevier), PsycINFO (EBSCO), Social Services Abstract (ProQuest), and CINAHL (EBSCO) databases from 1990 onward on August 12, 2020. We analyzed studies describing explicit TIC interventions in the ED setting using inductive qualitative content analysis to identify recurrent themes and identify unique trauma-informed interventions in each study. Studies not explicitly citing TIC were excluded. Studies were assessed for bias using the Newcastle-Ottawa criteria and Critical Appraisal Skills Programme (CASP) Checklist.
We identified a total of 1,372 studies and abstracts, with 10 meeting inclusion criteria for final analysis. Themes within TIC interventions that emerged included educational interventions, collaborations with allied health professionals and community organizations, and patient and clinician safety interventions. Educational interventions included lectures, online modules, and standardized patient exercises. Collaborations with community organizations focused on addressing social determinants of health. All interventions suggested a positive impact from TIC on either clinicians or patients, but outcomes data remain limited.
Trauma-informed care is a nascent field in EM with limited operationalization of TIC approaches. Future studies with patient and clinician outcomes analyzing universal TIC precautions and systems-level interventions are needed.
创伤暴露是急诊医学（EM）中患者和临床医生普遍存在的经历。创伤知情护理（TIC）是减轻创伤对健康负面影响的有效框架。本系统综述综合了 EM 中 TIC 干预措施的范围，重点关注患者和临床医生的结果，并确定了当前 TIC 实施研究中的空白。
该研究在 PROSPERO（CRD42020205182）上注册。我们系统地搜索了 1990 年以来的同行评议期刊和 PubMed、EMBASE（Elsevier）、PsycINFO（EBSCO）、社会服务摘要（ProQuest）和 CINAHL（EBSCO）数据库中的摘要。我们分析了描述 ED 环境中明确 TIC 干预措施的研究，使用归纳定性内容分析来确定反复出现的主题，并确定每个研究中独特的创伤知情干预措施。未明确引用 TIC 的研究被排除在外。使用纽卡斯尔-渥太华标准和批判性评估技能计划（CASP）检查表评估研究的偏倚。
我们共确定了 1372 项研究和摘要，其中 10 项符合最终分析的纳入标准。TIC 干预措施中的主题包括教育干预、与联合健康专业人员和社区组织的合作，以及患者和临床医生的安全干预措施。教育干预包括讲座、在线模块和标准化患者练习。与社区组织的合作侧重于解决健康的社会决定因素。所有干预措施都表明 TIC 对临床医生或患者都有积极影响，但结果数据仍然有限。
TIC 在 EM 中是一个新兴领域，对 TIC 方法的实施有限。需要对具有患者和临床医生结果的未来研究进行分析，以确定普遍的 TIC 预防措施和系统级干预措施。
