实施静脉血栓栓塞指南和电子健康记录医嘱集对创伤患者静脉血栓栓塞发生率的影响：一项多中心研究。
Impact of implementing a venous thromboembolism guideline and electronic health records order set on venous thromboembolism rates in trauma patients: A multicenter study.
作者信息
Lee Janet S, Johnson Emily, Schmoekel Nathan H, McIntyre Robert C, Wright Franklin L, Cripps Michael W, Cribari Chris, Dorlac Warren C, LaGrone Lacey N, Brockman Valerie, Cotner-Pouncy Tracy, Schroeppel Thomas J
机构信息
From the Department of Trauma and Acute Care Surgery (J.S.L., E.J., N.H.S., V.B., T.J.S.), UCHealth Memorial Hospital, Colorado Springs; Department of Surgery (J.S.L., E.J., R.C.M., F.L.W., M.W.C.), University of Colorado Anschutz Medical Campus, Aurora; and Department of Trauma and Acute Care Surgery (C.C., W.C.D., L.N.L., T.C.-P.), UCHealth Medical Center of the Rockies, Loveland, Colorado.
出版信息
J Trauma Acute Care Surg. 2025 Aug 1;99(2):212-218. doi: 10.1097/TA.0000000000004628. Epub 2025 Apr 15.
BACKGROUND
Appropriate chemical prophylaxis can reduce the risk of venous thromboembolism (VTE) in trauma patients. A system-wide VTE clinical practice guideline (CPG) and electronic health record (EHR)-based VTE prophylaxis order set were implemented. The CPG provided guidelines based on bleeding risk, recommended earlier initiation of chemical prophylaxis, and favored low-molecular-weight heparin (LMWH). The purpose of this study was to evaluate the impact of VTE CPG and prophylaxis order set on the rate of VTE.
METHODS
A retrospective review was performed on trauma patients 15 years or older admitted to three trauma centers between July 2018 and December 2021. Exclusion criteria included burn injury, readmission, length of stay <2 days, and withdrawal of care. The VTE CPG and EHR order set were implemented in November 2020, and a pre-implementation/postimplementation (POST) comparison was conducted.
RESULTS
A total of 12,479 patients were included. There were no differences in age, sex, and Injury Severity Score. The POST group had a higher usage of LMWH (64.0 vs. 67.5%, p < 0.01), a lower rate of no prophylaxis (17.2 vs. 12.5%, p < 0.01), and a shorter time to prophylaxis (29.4 vs. 25.9 hours, p < 0.01). The rates of VTE (1.6 vs. 1.0%, p < 0.01) and deep vein thrombosis (1.1 vs. 0.7%, p = 0.03) were lower in the POST group. There was no difference in the rate of pulmonary embolism (0.6 vs. 0.4%, p = 0.06). The POST group had a higher mortality (0.7 vs. 1.1%, p = 0.03) on univariable analysis, but there were no differences between groups on adjusted analysis. Independent predictors of VTE were longer time to VTE prophylaxis, higher Injury Severity Score, ventilator-associated pneumonia, and longer hospital length of stay. Use of LMWH and postintervention period were protective from VTE.
CONCLUSIONS
The implementation of a system-wide VTE CPG and EHR-based prophylaxis order set were associated with a reduced incidence of VTE in trauma patients without an associated mortality difference.
LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
背景
适当的化学预防可降低创伤患者静脉血栓栓塞症（VTE）的风险。实施了全系统的VTE临床实践指南（CPG）和基于电子健康记录（EHR）的VTE预防医嘱集。CPG根据出血风险提供指导，建议更早开始化学预防，并倾向于使用低分子量肝素（LMWH）。本研究的目的是评估VTE CPG和预防医嘱集对VTE发生率的影响。
方法
对2018年7月至2021年12月期间入住三个创伤中心的15岁及以上创伤患者进行回顾性研究。排除标准包括烧伤、再次入院、住院时间<2天和放弃治疗。VTE CPG和EHR医嘱集于2020年11月实施，并进行了实施前/实施后（POST）比较。
结果
共纳入12479例患者。年龄、性别和损伤严重程度评分无差异。POST组LMWH的使用率更高（64.0%对67.5%，p<0.01），无预防措施的比例更低（17.2%对12.5%，p<0.01），预防开始时间更短（29.4小时对25.9小时，p<0.01）。POST组的VTE发生率（1.6%对1.0%，p<0.01）和深静脉血栓形成率（1.1%对0.7%，p=0.03）更低。肺栓塞发生率无差异（0.6%对0.4%，p=0.06）。单因素分析显示POST组死亡率更高（0.7%对1.1%，p=0.03），但调整分析后两组无差异。VTE的独立预测因素包括VTE预防时间更长、损伤严重程度评分更高、呼吸机相关性肺炎和住院时间更长。使用LMWH和干预后时期可预防VTE。
结论
全系统VTE CPG和基于EHR的预防医嘱集的实施与创伤患者VTE发生率降低相关，且无相关死亡率差异。
证据水平
预后和流行病学；IV级。
Zotero 插件