对前腹刺伤的临床观察算法在澳大利亚的环境中是安全的
Aswin Shanmugalingam1, Priyadarshani Samarasinghe1, Kerry Hitos1,2
1Westmead Surgical Department, Westmead Hospital, Sydney, Australia.
ANZ journal of surgery
|July 4, 2024
概括
临床观察算法 (COA) 是一种安全有效的方法,用于管理澳大利亚的腹部和腹部 (AASW) 患者. 这种方法显著减少了非治疗性腹腔切除术,同时确保没有错过的伤害.
科学领域:
- 创伤外科手术是什么
- 手术诊断手术诊断手术诊断手术诊断手术诊断手术诊断
- 紧急医疗 紧急医疗
背景情况:
- 对AASW的诊断性腹腔镜具有高灵敏度,但非治疗性腹腔切除的比例很高 (54%).
- 报告了临床观察算法 (COA),但主要来自大批量中心.
- 澳大利亚对AASW管理的COA在澳大利亚环境中的安全性和有效性尚未被探索.
研究的目的:
- 评估澳大利亚创伤中心AASW患者COA的诊断准确性和安全性.
- 确定COA是否可以减少AASW的非治疗性手术干预.
- 在这个患者群体中,将COA与诊断性腹腔镜的结果进行比较.
主要方法:
- 澳大利亚悉尼1级创伤中心AASW患者的前性队列研究 (2021年6月 - 2023年8月).
- 从电子医疗记录和创伤登记处收集的数据包括患者人口统计数据,伤害细节,管理和结果.
- 分析的重点是COA诊断准确性 (灵敏度,特异性,PPV,NPV),并发症率和住院时间 (LOS) 的中位数.
主要成果:
- 分析了48名AASW患者,11名 (22.9%) 接受了立即腹腔切除术.
- 30名患者接受了COA治疗,结果只有3人 (10%) 需要随后的腹腔切除术,只有1人 (3.3%) 没有治疗效果.
- 在COA组中,COA表现出100%的灵敏度,92.7%的特异性和100%的NPV,而COA组中没有错过的伤害或并发症. 中位数LOS为1天.
结论:
- COA是一种安全有效的策略,用于在资源充足的澳大利亚环境中评估AASW患者.
- 与诊断性腹腔镜相比,实施COA显著减少了非治疗性手术干预.
- COA提供了可接受的患者结果,也是AASW管理的可行替代方案.
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