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创伤患者静脉血栓栓塞预防的实施科学方法:2022 年实施创伤最佳静脉血栓栓塞预防共识会议的研究结果。

Implementation science approaches to optimizing venous thromboembolism prevention in patients with traumatic injuries: Findings from the 2022 Consensus Conference to Implement Optimal Venous Thromboembolism Prophylaxis in Trauma.

机构信息

From the Department of Surgery (A.R.), Division of Trauma and Surgical Critical Care, Drexel College of Medicine, Philadelphia, Pennsylvania; Christianacare Health (A.R.), Newark, Delaware; Thromboembolism Program, Sunnybrook Health Sciences Centre, Department of Medicine (W.G.), University of Toronto, Toronto, Canada; Division of Acute Care Surgery, Department of Surgery (E.R.H.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine (E.R.H.), Johns Hopkins University School of Medicine, Baltimore, Maryland; and Department of Emergency Medicine (E.R.H.), Johns Hopkins University School of Medicine, Baltimore, Maryland, Armstrong Institute for Patient Safety and Quality (E.R.H.), Johns Hopkins Medicine Baltimore, Maryland; Department of Health Policy and Management (E.R.H.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Coalition for National Trauma Research (M.P.), San Antonio, Texas; Division of Trauma, Surgical Critical Care and Burn Surgery, Department of Surgery (T.C.), University of California San Diego, California; and Division of Trauma and Acute Care Surgery, Department of Surgery (P.M.), Medical College of Wisconsin, Milwaukee, Wisconsin.

出版信息

J Trauma Acute Care Surg. 2023 Mar 1;94(3):490-494. doi: 10.1097/TA.0000000000003850. Epub 2022 Dec 6.

Abstract

Disease burden of venous thromboembolism (VTE) without pharmacologic prophylaxis is high in trauma patients. Although VTE prophylaxis guidelines exist, studies on real-world use of VTE prophylaxis in trauma shows limited uptake of guideline recommendations. Despite existing guidelines, reports indicate that VTE prophylaxis implementation across trauma centers is lagging. Implementation barriers of VTE prophylaxis in trauma are multifactorial, and VTE prescribing practices require further optimization. Implementation science methods can help standardize and improve care; well-established approaches in medical and surgical hospitalized patients and their effects on clinical outcomes such as VTE and bleeding complications must be investigated because they apply to trauma patients. Nonadministration of VTE prophylaxis medications in hospitalized patients is associated with VTE events and remains a barrier to providing optimal defect-free care. Further investigations are required for VTE prophylaxis implementation across all trauma populations.

摘要

创伤患者若未接受药物预防静脉血栓栓塞症(venous thromboembolism,VTE),其疾病负担很高。尽管存在 VTE 预防指南,但有关创伤中 VTE 预防实际应用的研究表明,指南推荐的接受程度有限。尽管存在指南,但报告表明,创伤中心的 VTE 预防实施情况滞后。创伤中 VTE 预防的实施障碍是多因素的,并且 VTE 处方实践需要进一步优化。实施科学方法可以帮助规范和改善护理;必须研究在医疗和外科住院患者中已经确立的方法及其对 VTE 和出血等并发症等临床结果的影响,因为它们适用于创伤患者。在住院患者中未给予 VTE 预防药物与 VTE 事件相关,仍然是提供无缺陷最佳护理的障碍。需要进一步研究所有创伤人群的 VTE 预防实施情况。

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