创伤患者的医院前管理从半刚性变为软领的变化:一项观察性研究
Biswadev Mitra1,2, Stephen Bernard2,3, Cassandra Yankoff1,2
1Emergency & Trauma Centre Alfred Health Melbourne Victoria Australia.
概括
在怀疑宫脊椎损伤时切换到软领,增加了CT扫描和急诊室的清除. 这一变化没有影响脊髓损伤,压伤或肺炎的发生率,但建议进一步监测.
科学领域:
- 紧急医疗 紧急医疗
- 创伤护理 创伤护理
- 脊柱损伤管理 脊柱损伤管理
背景情况:
- 椎脊柱的保护在多系统创伤中至关重要.
- 维多利亚救护车在2021年更新了指导方针,建议在怀疑宫脊椎损伤时使用软领,而不是半硬领.
- 这一转变旨在评估对诊断成像和患者结果的影响.
研究的目的:
- 在指南变更后,评估椎脊柱成像实践的变化.
- 为了确定软领的使用是否影响了压力的发生率,医院获得的肺炎和脊髓损伤.
- 为了比较半刚性和软领在医院前环境中的使用结果.
主要方法:
- 采用了回顾性干预前后研究设计.
- 数据是从连续提交到澳大利亚墨尔本主要创伤中心的患者收集的.
- 分析了指导方针变更之前和之后的两个3个月期间.
主要成果:
- 共有1762名患者被纳入该研究.
- 宫脊椎的计算机断层扫描 (CT) 扫描在使用软领时显著增加 (88.4% vs 93.8%,p=0.001).
- 软领与在急诊室的椎清除率较高有关 (OR 4.14). 在压伤,医院获得的肺炎或脊髓损伤率方面没有发现显著差异.
结论:
- 在医院前护理中过渡到软领导致CT检查的增加和ED中椎脊柱清除的加快.
- 虽然在不良结果中没有发现显著差异,但该研究不足以排除微小的变化.
- 对怀疑部受伤的软领使用的持续监测是有必要的,以确保患者的安全和最佳护理.
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