挪威创伤协议的准确性. 来自挪威西南部的一个观察性人口研究
Guro Bjørke1, Ingvild Dalen2, Kenneth Thorsen3
1Section for Traumatology, Surgical Clinic, Stavanger University Hospital, Stavanger, Norway; Haukeland University Hospital, Voss Hospital Department Of Surgery, Bergen, Norway.
Injury
|December 7, 2024
概括
目前的挪威创伤小组激活 (TTA) 协议显示过量选和不足选率很高,特别是在老年患者中. 包括特殊考虑标准可以提高TTA协议的性能.
科学领域:
- 紧急医疗 紧急医疗
- 创伤外科 手术 创伤外科
- 公共卫生政策 公共卫生政策
背景情况:
- 挪威创伤计划 (2007年,更新至2017年) 建立了国家创伤队激活 (TTA) 标准.
- 以前的验证研究表明,TTA协议的过量选和不足选率低于最佳.
- 迄今为止还没有研究验证了更新的TTA协议的性能.
研究的目的:
- 为了验证当前挪威TTA协议的性能.
- 评估替代TTA协议和标准组对过量选和不足选的影响.
- 确定需要改进的TTA协议领域.
主要方法:
- 使用前性维护创伤数据 (2018-2020) 的注册表研究.
- 1424名符合条件的患者被根据29个标准评估,分为四组:生理学,解剖损伤,损伤机制和特殊考虑.
- 对当前和替代TTA协议的过量选,不足选,灵敏度和正预测值 (PPV) 的分析.
主要成果:
- 目前的TTA协议 (标准组1-3) 显示15.2%的不足和80.8%的过量.
- 较年长的患者 (≥60岁) 与较年轻的患者 (11.2%) 相比,体验了较高的低位 (21.6%).
- 包括"特殊考虑" (4组) 在内,降低了不足选率至5.6%,但没有显著增加过量选.
结论:
- 过量选和不足选都偏离了挪威创伤计划的目标.
- 不符合当前TTA标准的老年患者在显著程度上导致了选不足.
- 修改标准组,删除低PPV标准,提高合规性,可以提高TTA协议的有效性.
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