老年创伤重症监护室入院指南与计划外的重症监护室入院减少有关
Maria Thurston1, Tyler Robinson1, Taruni Pandhiri1
1Indiana University Department of Surgery, Indianapolis, Indiana.
The Journal of surgical research
|September 3, 2024
概括
实施老年创伤重症监护病房 (ICU) 入院指南将老年创伤患者的非计划性ICU入院 (UIA) 减少了一半. 这项质量改善计划改善了初级护理水平,但没有影响死亡率或再入院率.
科学领域:
- 创伤外科 手术 创伤外科
- 老年医学 老年医学
- 密集护理医学 密集护理医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 老年创伤患者面临的结果比年轻的同行具有类似的伤害更糟糕.
- 制定了老年创伤重症监护病房 (ICU) 招生指南,以加强对高风险老年患者的早期护理.
- 该指南旨在减少计划外的ICU入院 (UIA),这是不良结果的关键指标.
研究的目的:
- 评估实施老年创伤ICU入院指南对老年创伤患者的UIAs的影响.
- 评估指南实施后的二次结果,包括死亡率,停留时间和再接收.
主要方法:
- 创伤登记数据的回顾性分析在一级创伤中心进行.
- 符合ICU入院标准的老年患者在指南实施前和之后 (2020年7月1日) 进行了比较.
- 统计分析包括t测试,曼·惠特尼U,奇平方和风险调整回归来比较结果.
主要成果:
- 实施后的组显示了≥3个肋骨骨折的更高发病率和初始ICU护理水平的增加.
- 该指南的实施与UIAs减少50% (调整后几率比0.52) 相联系.
- 在死亡率,30天再入院或各种自由日指标方面没有发现显著差异.
结论:
- 老年创伤重症监护室入院指南有效地将UIA在目标老年创伤人群中减少了一半.
- 该指南并没有显著改变死亡率,再入院率或无患者日.
- 建议进行进一步的研究,以完善指导方针,评估妄想的影响,并建立安全降级的标准.
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