护理人员判断是创伤选的基础:这是一个有效的策略吗?
Matthew P Schaefer1, Chrisnel Lamy1, Dalier Mederos-Rodriguez2
1Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
The American surgeon
|January 15, 2025
概括
护理人员判断 (PJ) 导致过度选 (68.9%) 与标准创伤选标准 (SC) (54.8%) 相比显著增加. 这突显了创伤激活协议的潜在效率低下,强调需要精细的指导方针,以平衡患者安全和资源分配.
科学领域:
- 创伤外科 手术 创伤外科
- 紧急医疗 紧急医疗
- 公共卫生 公共卫生
背景情况:
- 美国外科医生学院创伤委员会 (ACS-COT) 制定了1级创伤激活的标准标准 (SC).
- 医院可以允许医院前人员的护理人员判断 (PJ) 在不满足SC的情况下启动全创伤选激活 (FTTA).
研究的目的:
- 评估和比较护理人员判断 (PJ) 和创伤激活标准标准 (SC) 之间的过量选和不足选率.
- 评估需要紧急干预-6 (NEI-6) 模型在创伤分类中的有效性.
主要方法:
- 从2019年1月到2023年1月对1846名患者的回顾性分析.
- 使用克里巴里矩阵进行分级分类 (低于,超过,适当).
- 采用奇二次测试和调整的二项逻辑回归来比较PJ和SC组之间的分拣结果.
主要成果:
- 在PJ组 (68.9%) 与SC组 (54.8%) (P ≤ .05) 相比,PJ组的过量治疗显著更高.
- 在PJ组 (1.23%) 与SC组 (0.13%) 之间,低选率更高.
- 调整后的分析显示,PJ比SC (OR2.04;P<.01) 导致过量选的可能性高2.04倍. 在PJ患者中,需要输血的可能性是三分之一 (OR 0.33;P < .01).
结论:
- 护理人员判断 (PJ) 导致在大型城市创伤中心,与标准标准 (SC) 相比,过量选增加了2倍.
- 虽然 undertriage 低,但与 PJ 相关的高过量选率需要进一步调查和潜在的协议改进.
- NEI-6模型的实用性需要进一步验证以进行准确的创伤选评估.
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