穿透腹部创伤患者的时间到OR的结果
Braylee Grisel1, Alexander Gordee2, Maragatha Kuchibhatla2
1Division of Trauma and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
The American journal of emergency medicine
|March 3, 2024
概括
时间到OR是一个关键的创伤指标,但更快的时间并不总是改善患者的结果. 个体患者数据显示,每节省一分钟的OR时间都会降低死亡风险.
科学领域:
- 创伤外科 手术 创伤外科
- 改善医疗保健质量 改善医疗保健质量
- 过程测量 过程测量
背景情况:
- 时间到OR是创伤护理中广泛使用的过程测量方法.
- 它对患者死亡率和并发症率的直接影响仍在争论中.
- 现有的证据并不总是将更快的设施时间与更好的结果联系起来.
研究的目的:
- 评估设施级时间到OR速度和患者死亡率之间的关联.
- 为了确定个体患者的时间到OR对死亡率和并发症的影响.
- 评估 Time-to-OR 与穿透腹部创伤和枪支伤害的结果之间的关系.
主要方法:
- 使用创伤质量改善计划 (TQIP) 数据库.
- 根据第75个百分点的时间到OR,将医院分为缓慢,平均和快速.
- 采用通用估计方程 (GEE) 来分析设施和患者层面的死亡率.
主要成果:
- 设施的速度与所有穿透创伤或仅使用枪支的患者的死亡率没有显著关联.
- 在患者层面,每增加一分钟的时间到OR与住院死亡率的几率下降有关 (OR 0.985).
- 失败救援分析没有显示出因设施速度而导致的死亡率差异,但随着患者水平的增加,死亡率下降了.
结论:
- 目前在设施层面的时间到OR指标显示,改善创伤患者结果的证据有限.
- 个体患者 Time-to-OR 显示了与减少住院死亡率的统计学上显著的关联.
- 建议开发创伤绩效指标,以更好地反映患者的结果.
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