Author Affiliations: College of Nursing, University of Kentucky, Lexington, Kentucky (Ms. Silverstein and Drs. Moser and Rayens).
J Trauma Nurs. 2024;31(4):189-195. doi: 10.1097/JTN.0000000000000797. Epub 2024 Jul 4.
About 3.5 million trauma patients are hospitalized every year, but 35%-40% require further care after discharge. Nurses' ability to affect discharge disposition by minimizing the occurrence of nurse-sensitive indicators (catheter-associated urinary tract infection [CAUTI], central line-associated bloodstream infection [CLABSI], and hospital-acquired pressure injury [HAPI]) is unknown. These indicators may serve as surrogate measures of quality nursing care.
The purpose of this study was to determine whether nursing care, as represented by three nurse-sensitive indicators (CAUTI, CLABSI, and HAPI), predicts discharge disposition in trauma patients.
This study was a secondary analysis of the 2021 National Trauma Data Bank. We performed logistic regression analyses to determine the predictive effects of CAUTI, CLABSI, and HAPI on discharge disposition, controlling for participant characteristics.
A total of n = 29,642 patients were included, of which n = 21,469 (72%) were male, n = 16,404 (64%) were White, with a mean (SD) age of 44 (14.5) and mean (SD) Injury Severity Score of 23.2 (12.5). We created four models to test nurse-sensitive indicators, both individually and compositely, as predictors. While CAUTI and HAPI increased the odds of discharge to further care by 1.4-1.5 and 2.1 times, respectively, CLABSI was not a statistically significant predictor.
Both CAUTI and HAPI are statistically significant predictors of discharge to further care for patients after traumatic injury. High-quality nursing care to prevent iatrogenic complications can improve trauma patients' long-term outcomes.
每年约有 350 万创伤患者住院，但其中 35%-40%在出院后仍需要进一步治疗。护士通过最大限度地减少护士敏感指标（导尿管相关尿路感染[CAUTI]、中心静脉相关血流感染[CLABSI]和医院获得性压力性损伤[HAPI]）的发生来影响出院处置的能力尚不清楚。这些指标可以作为护理质量的替代衡量标准。
本研究旨在确定护理是否能通过三个护士敏感指标（CAUTI、CLABSI 和 HAPI）预测创伤患者的出院处置。
本研究是对 2021 年国家创伤数据库的二次分析。我们进行了逻辑回归分析，以确定 CAUTI、CLABSI 和 HAPI 对出院处置的预测效果，同时控制参与者的特征。
共纳入 29642 例患者，其中 21469 例（72%）为男性，16404 例（64%）为白人，平均年龄（标准差）为 44（14.5）岁，平均损伤严重度评分（标准差）为 23.2（12.5）。我们创建了四个模型来测试护士敏感指标，分别单独和综合作为预测因素。虽然 CAUTI 和 HAPI 分别使出院到进一步治疗的可能性增加了 1.4-1.5 倍和 2.1 倍，但 CLABSI 不是一个统计学上显著的预测因素。
CAUTI 和 HAPI 均是创伤后患者出院到进一步治疗的统计学上显著的预测因素。预防医源性并发症的高质量护理可以改善创伤患者的长期预后。
