Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Department of Surgery, School of Medicine, University for Development Studies, Tamale, Ghana.
J Pediatr Surg. 2024 Jun;59(6):1210-1218. doi: 10.1016/j.jpedsurg.2023.12.001. Epub 2023 Dec 10.
This study aimed to determine the effectiveness of a standardized trauma intake form (TIF) to improve achievement of key performance indicators (KPIs) of initial trauma care among injured children, compared to adults, at non-tertiary hospitals in Ghana.
A stepped-wedge cluster randomized trial was performed with research assistants directly observing the management of injured patients before and after introducing the TIF at emergency units of 8 non-tertiary hospitals for 17.5 months. Differences in outcomes between children and adults in periods before and after TIF introduction were determined with multivariable logistic regression. Differences in outcomes among children after TIF introduction were determined using generalized linear mixed regression.
Management of 3889 injured patients was observed; 757 (19%) were children <18 years. Trauma care KPIs at baseline were lower for children compared to adults. Improvements in primary survey KPIs were observed among children after TIF introduction. Examples include airway assessment [279 (71%) to 359 (98%); adjusted odds ratio (AOR): 74.42, p = 0.005)] and chest examination [225 (58%) to 349 (95%); AOR 53.80, p = 0.002)]. However, despite these improvements, achievement of KPIs was still lower compared to adults. Examples are pelvic fracture evaluation [children: 295 (80%) vs adults: 1416 (88%), AOR: 0.56, p = 0.001] and respiratory rate assessment (children: 310 (84%) vs adults: 1458 (91%), AOR: 058, p = 0.030).
While the TIF was effective in improving most KPIs of pediatric trauma care, more targeted education is needed to bridge the gap in quality between pediatric and adult trauma care at non-tertiary hospitals in Ghana and other low- and middle-income countries.
Stepped-wedged cluster randomized controlled trial.
I.
本研究旨在确定标准化创伤录入表（TIF）在改善加纳非三级医院对受伤儿童初始创伤护理关键绩效指标（KPI）的应用效果，与成人比较。
采用阶梯式楔形群随机试验，在 17.5 个月内，研究助理在非三级医院急诊部引入 TIF 前后直接观察受伤患者的管理情况。采用多变量逻辑回归确定 TIF 引入前后儿童和成人之间的结果差异。采用广义线性混合回归确定 TIF 引入后儿童之间的结果差异。
共观察到 3889 名受伤患者的管理情况，其中 757 名（19%）为＜18 岁儿童。基线时，儿童创伤护理 KPI 低于成人。TIF 引入后，儿童的初步调查 KPI 有所改善。例如气道评估[279（71%）至 359（98%）；调整后的优势比（AOR）：74.42，p=0.005]和胸部检查[225（58%）至 349（95%）；AOR 53.80，p=0.002)]。然而，尽管有这些改善，但 KPI 的实现率仍低于成人。例如骨盆骨折评估[儿童：295（80%）与成人：1416（88%），AOR：0.56，p=0.001]和呼吸频率评估（儿童：310（84%）与成人：1458（91%），AOR：058，p=0.030）。
虽然 TIF 有效地提高了儿科创伤护理的大多数 KPI，但加纳和其他中低收入国家的非三级医院需要更有针对性的教育，以缩小儿科和成人创伤护理质量之间的差距。
阶梯式楔形群随机对照试验。
I。
