创伤:使创伤临床指导更容易实施
Danielle J Wilson1, Gabriela Zavala Wong2, Christopher Tignanelli3
1Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Trauma surgery & acute care open
|September 9, 2025
概括
创伤临床指导改善了患者的结果,但未得到充分利用. 这项研究发现,现有的创伤指南缺乏关键的可实施性元素,这表明需要改进发展策略.
科学领域:
- 创伤学 创伤学 创伤学
- 改善医疗保健质量 改善医疗保健质量
- 临床指南开发 临床指南开发
背景情况:
- 创伤临床指导被证明可以提高患者的治疗结果.
- 目前创伤临床指导的利用率低于最佳水平,影响了患者的护理.
- 影响指导实施的因素包括内在的 (格式) 和外在的 (环境) 元素.
研究的目的:
- 评估现有的创伤临床指导,以确定必要的可实施性要素.
- 识别当前创伤指南中的缺陷,阻碍其实际应用.
- 假设创伤临床指导缺乏有效实施的关键要素.
主要方法:
- 准则可执行性框架 (Gagliardi) 用于评估.
- 来自11个专业组织的20份创伤临床指导文件的样本被审查.
- 数据提取的重点是指导方针中22个可实施性元素的存在或不存在.
主要成果:
- 所有审查的指南都有明确的目标,85%允许个性化应用.
- 大约50%包括用于可用性和正式证据分级的格式化辅助工具.
- 很少有指南包含患者友好的工具 (10%),实施策略 (25%) 或质量指标 (30%).
结论:
- 创伤临床指导从叙事文档到可执行工具各不相同.
- 修改指南,即使是免费的,也可以改善在各种临床环境中的实施.
- 拟议的TRAUMA框架 (透明度,强大的包容性,适应性,可用性,可测量性,可访问性) 提供了增强指导实施性和患者结果的要素.
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