在北美,骨盆骨折后死亡率下降
Soroush Shabani1, Annie Zhang1, Julian Wier1
1Keck School of Medicine of the University of Southern California, Los Angeles, USA.
概括
开放骨盆骨折的住院死亡率从2017年减少到2022年. 这种下降与不断变化的管理策略有关,包括更多地使用腹前骨盆包装 (PPP) 和减少探索性腹腔切除术 (EL) 的使用.
科学领域:
- 创伤外科 手术 创伤外科
- 手术重症监护手术重症监护
- 骨科创伤的创伤是什么
背景情况:
- 露骨骨盆骨折存在很大的死亡风险,需要多学科的方法.
- 管理策略,包括血管栓塞 (AE),探索性腹腔切除术 (EL) 和腹前骨盆包装 (PPP),已经发展.
- 这些不断变化的做法与死亡率结果之间的关联仍然不清楚.
研究的目的:
- 评估开放骨盆骨折的住院死亡率的趋势.
- 评估复苏和出血控制干预措施变化的对死亡率的影响.
- 确定不断变化的实践模式是否与死亡率降低有关.
主要方法:
- 来自美国外科医生学院创伤质量改善计划的成人骨盆骨折患者 (2017-2022) 的回顾性分析.
- 主要结局:住院死亡率. 使用多变量逻辑回归计算的调整后的死亡风险.
- 干预趋势 (AE,EL,PPP) 每年使用千平方和克鲁斯卡尔-瓦利斯测试进行评估.
主要成果:
- 总共有10,172名患者被分析;平均调整后死亡率为10.78%,每年显著下降0.43% (p=0.001).
- 血管栓塞率 (AE) 保持稳定. 探索性腹腔切除术 (EL) 的发生率下降 (0.60%/年,p<0.001),而腹前盆腔包装 (PPP) 的发生率增加 (0.76%/年,p<0.001).
- 中级创伤中心 (400-600张床位) 报告说,由于骨盆骨折而增加了入院人数.
结论:
- 在2017年至2022年间,经开放骨盆骨折的住院死亡率下降.
- 这种改善与相关的低血压急性管理实践的不断变化相关.
- 增加PPP的使用率和减少EL的使用率反映了这些实践模式的转变.
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