儿童创伤护理中的低价值临床实践
Theony Deshommes1,2,3, Gabrielle Freire4,5, Natalie Yanchar6
1Department of Social and Preventive Medicine, School of Medicine, Laval University, Québec City, Québec, Canada.
JAMA network open
|October 29, 2024
概括
在儿科创伤中,低价值护理是常见的,医院之间存在显著差异. 这些做法,包括不必要的成像和入院,提供了通过撤销策略改善的机会.
科学领域:
- 儿科创伤护理 儿童创伤护理
- 医疗保健服务研究 医疗服务研究
- 提高质量 提高质量
背景情况:
- 减少低价值护理可以提高患者体验,优化医疗保健资源利用率.
- 虽然在成人创伤中经常发生,但儿童创伤护理中低价值实践的证据有限.
研究的目的:
- 为了确定儿童创伤护理中低价值实践的发生率.
- 评估这些做法在不同医院的差异.
主要方法:
- 一项回顾性队列研究分析了加拿大省级创伤系统 (2016-2022) 中16岁以下的10,711名儿童的数据.
- 从系统性审查和临床指南中确定了低价值的做法.
- 对已识别的做法进行了发病率和医院间变化 (使用ICC) 的评估.
主要成果:
- 确定了19种低价值的做法;14种可以通过创伤登记数据进行评估.
- 五个实践显示中度至高频率和医院间变化:低风险儿童的头部CT,转移前CT,神经外科咨询和轻度TBI或轻微腹部创伤的住院.
- 具体的例子包括38.8%的轻度创伤性脑损伤住院患者,具有高的医院间变异 (ICC 12.4%).
结论:
- 低价值实践在儿科创伤护理中普遍存在,并表现出显著的医院间变异性.
- 这些发现突出了撤销实施干预的机会,特别是对于可用现有数据衡量的做法.
- 针对这些做法可以提高儿童创伤的护理质量和资源效率.
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