标准化创伤录入表单结合临床决策支持提示可改善加纳非三甲医院严重创伤患者的救治并降低死亡率：阶梯式随机对照试验。
Standardized trauma intake form with clinical decision support prompts improves care and reduces mortality for seriously injured patients in non-tertiary hospitals in Ghana: stepped-wedge cluster randomized trial.
机构信息
Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Surgery Unit, University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
出版信息
Br J Surg. 2023 Oct 10;110(11):1473-1481. doi: 10.1093/bjs/znad253.
BACKGROUND
The WHO Trauma Care Checklist improved key performance indicators (KPIs) of trauma care at tertiary hospitals. A standardized trauma intake form (TIF) with real-time clinical decision support prompts was developed by adapting the WHO Trauma Care Checklist for use in smaller low- and middle-income country hospitals, where care is delivered by non-specialized providers and without trauma teams. This study aimed to determine the effectiveness of the TIF for improving KPIs in initial trauma care and reducing mortality at non-tertiary hospitals in Ghana.
METHODS
A stepped-wedge cluster randomized trial was conducted by stationing research assistants at emergency units of eight non-tertiary hospitals for 17.5 months to observe management of injured patients before and after introduction of the TIF. Differences in performance of KPIs in trauma care (primary outcomes) and mortality (secondary outcome) were estimated using generalized linear mixed regression models.
RESULTS
Management of 4077 injured patients was observed (2067 before TIF introduction, 2010 after). There was improvement in 14 of 16 primary survey and initial care KPIs after TIF introduction. Airway assessment increased from 72.9 to 98.4 per cent (adjusted OR 25.27, 95 per cent c.i. 2.47 to 258.94; P = 0.006) and breathing assessment from 62.1 to 96.8 per cent (adjusted OR 38.38, 4.84 to 304.69; P = 0.001). Documentation of important clinical data improved from 52.4 to 76.7 per cent (adjusted OR 2.14, 1.17 to 3.89; P = 0.013). The mortality rate decreased from 17.7 to 12.1 per cent among 302 patients (186 before, 116 after) with impaired physiology on arrival (hypotension or decreased level of consciousness) (adjusted OR 0.10, 0.02 to 0.56; P = 0.009).
CONCLUSION
The TIF improved overall initial trauma care and reduced mortality for more seriously injured patients.
REGISTRATION NUMBER
NCT04547192 (http://www.clinicaltrials.gov).
背景
世界卫生组织创伤护理检查表提高了三级医院创伤护理的关键绩效指标 (KPI)。通过改编世界卫生组织创伤护理检查表，为在资源较少的中低收入国家的医院中使用开发了标准化的创伤入院表（TIF），并提供实时临床决策支持提示。这些医院的护理由非专业人员提供，且没有创伤团队。本研究旨在确定 TIF 在改善加纳非三级医院初始创伤护理的 KPI 和降低死亡率方面的有效性。
方法
通过在 8 家非三级医院的急诊部门派驻研究助理 17.5 个月，进行了一项逐步楔形集群随机试验，以观察引入 TIF 前后创伤患者的管理情况。使用广义线性混合回归模型估计创伤护理 KPI（主要结局）和死亡率（次要结局）的差异。
结果
共观察到 4077 名受伤患者的治疗情况（引入 TIF 前 2067 名，引入 TIF 后 2010 名）。引入 TIF 后，16 项初步检查和初始护理 KPI 中的 14 项得到了改善。气道评估从 72.9%增加到 98.4%（调整后的 OR 25.27，95%置信区间 2.47 至 258.94；P = 0.006），呼吸评估从 62.1%增加到 96.8%（调整后的 OR 38.38，4.84 至 304.69；P = 0.001）。重要临床数据的记录从 52.4%提高到 76.7%（调整后的 OR 2.14，1.17 至 3.89；P = 0.013）。在因创伤导致生理功能受损（低血压或意识水平下降）而入院的 302 名患者（186 名在 TIF 引入前，116 名在 TIF 引入后）中，死亡率从 17.7%降至 12.1%（调整后的 OR 0.10，0.02 至 0.56；P = 0.009）。
结论
TIF 提高了整体初始创伤护理水平，并降低了严重受伤患者的死亡率。
注册号
NCT04547192（http://www.clinicaltrials.gov）。
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