Ratnasekera Asanthi, Seng Sirivan S, Ciarmella Marina, Gallagher Alexandria, Poirier Kelly, Harding Eric Shea, Haut Elliott R, Geerts William, Murphy Patrick
Surgery, Christiana Care Health System, Wilmington, Delaware, USA.
Crozer-Chester Medical Center, Upland, Pennsylvania, USA.
Trauma Surg Acute Care Open. 2024 Apr 25;9(1):e001420. doi: 10.1136/tsaco-2024-001420. eCollection 2024.
Venous thromboembolism (VTE) prophylaxis implementation strategies are well-studied in some hospitalized medical and surgical patients. Although VTE is associated with substantial mortality and morbidity in trauma patients, implementation strategies for the prevention of VTE in trauma appear to be based on limited evidence. Therefore, we conducted a systematic review and meta-analysis of published literature on active implementation strategies for VTE prophylaxis administration in hospitalized trauma patients and the impact on VTE events.
A systematic review and meta-analysis was performed in adult hospitalized trauma patients to assess if active VTE prevention implementation strategies change the proportion of patients who received VTE prophylaxis, VTE events, and adverse effects such as bleeding or heparin-induced thrombocytopenia as well as hospital length of stay and the cost of care. An academic medical librarian searched Medline, Scopus, and Web of Science until December 2022.
Four studies with a total of 1723 patients in the active implementation strategy group (strategies included education, reminders, human and computer alerts, audit and feedback, preprinted orders, and/or root cause analysis) and 1324 in the no active implementation strategy group (guideline creation and dissemination) were included in the analysis. A higher proportion of patients received VTE prophylaxis with an active implementation strategy (OR=2.94, 95% CI (1.68 to 5.15), p<0.01). No significant difference was found in VTE events. Quality was deemed to be low due to bias and inconsistency of studies.
Active implementation strategies appeared to improve the proportion of major trauma patients who received VTE prophylaxis. Further implementation studies are needed in trauma to determine effective, sustainable strategies for VTE prevention and to assess secondary outcomes such as bleeding and costs.
Systematic review/meta-analysis, level III.
CRD42023390538.
静脉血栓栓塞症（VTE）预防实施策略在一些住院内科和外科患者中已有充分研究。尽管VTE在创伤患者中与相当高的死亡率和发病率相关，但创伤患者VTE预防的实施策略似乎基于有限的证据。因此，我们对已发表的关于住院创伤患者VTE预防给药的积极实施策略及其对VTE事件影响的文献进行了系统评价和荟萃分析。
对成年住院创伤患者进行系统评价和荟萃分析，以评估积极的VTE预防实施策略是否会改变接受VTE预防的患者比例、VTE事件以及出血或肝素诱导的血小板减少等不良反应，以及住院时间和护理成本。一名医学专业图书馆员检索了截至2022年12月的Medline、Scopus和科学网。
分析纳入了四项研究，积极实施策略组共有1723例患者（策略包括教育、提醒、人工和计算机警报、审核与反馈、预印医嘱和/或根本原因分析），无积极实施策略组有1324例患者（制定和传播指南）。积极实施策略组接受VTE预防的患者比例更高（OR=2.94，95%CI（1.68至5.15），p<0.01）。VTE事件方面未发现显著差异。由于研究存在偏倚和不一致性，质量被认为较低。
积极实施策略似乎提高了接受VTE预防的主要创伤患者的比例。创伤领域需要进一步开展实施研究，以确定有效的、可持续的VTE预防策略，并评估出血和成本等次要结局。
系统评价/荟萃分析，III级。
PROSPERO注册号：CRD42023390538。
