对"一天百分比"规则的批判性评价 - - 一项基于登记的观察性研究
R L Brekke1, S K Almeland1, K O Hufthammer2
1Norwegian National Burn Center, Department of Plastic, Hand, and Reconstructive Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway.
Burns : journal of the International Society for Burn Injuries
|August 24, 2024
概括
"一天的百分比"规则不是烧伤患者住院的可靠预测指标,特别是对于较小的伤害. 住院时间存在显著差异,这限制了其用于个人患者预测的使用.
科学领域:
- 烧伤护理研究研究
- 临床有效性研究的临床有效性研究.
- 患者结局分析分析.
背景情况:
- "一天/百分比"规则是一个常见的启发式估计医院住院时间 (LOS) 的烧伤患者,基于总体表面积的百分比 (%TBSA) 烧伤.
- 这一规则建议每1%受烧伤影响的TBSA患者住院一天.
- 这项研究批判性地评估了这个规则在现实世界临床环境中的预测准确性.
研究的目的:
- 严格测试燃烧患者逗留时间的"一天百分比"规则的预测有效性.
- 为了确定特定的患者群体或损伤严重程度,规则可能不准确.
- 提供基于证据的见解,了解这种广泛使用的估计方法的局限性.
主要方法:
- 在2000年至2022年期间,使用挪威国家烧伤中心的数据进行了基于登记的观察性研究.
- 纳入标准包括在研究期间接受并积极治疗烧伤的所有儿童和成年人 (n=2269).
- 使用量子回归分析来评估%TBSA和LOS之间的关系,检查各种量子以了解数据分布.
主要成果:
- "一天百分比"规则对影响不到15%的TBSA的伤害的适用性不佳,中位数LOS/%TBSA比率往往超过1.0并且随着伤害规模较小而增加.
- 对于15%或更高的TBSA损伤,中位数LOS/%TBSA值接近1.0,但在成人和儿童的不同量度中观察到显著的变化.
- 儿童的LOS/%TBSA中位数比成年人更低,特别是15-30%TBSA之间的伤害. 患有严重烧伤 (>60%TBSA) 的幸存者中位数LOS/%TBSA比率较高.
结论:
- "一天的百分比"规则不是个体烧伤患者的可行的预测工具,因为它不准确,特别是在损伤<15%的TBSA.
- 患有相似烧伤范围的患者住院时间的大幅变化凸显了该规则在预测结果方面的局限性.
- 调查结果表明,在评估机构有效性或比较不同医疗保健机构时,该规则应该非常谨慎地使用,如果有的话.
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