Improving Trauma Care in Low- and Middle-Income Countries by Implementing a Standardized Trauma Protocol
Improving Trauma Care in Low- and Middle-Income Countries by Implementing a Standardized Trauma Protocol
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DOI：
10.1007/s00268-014-2534-y
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发表时间：
2014-08-01
影响因子：
2.6
通讯作者：
Rubiano, Andres M.
中科院分区：
文献类型：
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作者：
Kesinger, Matthew Ryan;Puyana, Juan Carlos;Rubiano, Andres M.
标准化的创伤协议（STP）降低了成熟创伤系统的发病率和死亡率。低收入和中等收入国家的大多数医院尚未实施此类协议，这通常是由于财政和后勤方面的限制。我们报告了创伤质量改进（QI）倡议的初步结果，在LMIC大学医院使用和评估低成本STP的影响。我们根据公认的最佳实践和损害控制复苏开发了STP。它是为测试机构的可用资源而设计的。内瓦大学医院（英语：Neiva University Hospital）是一家位于哥伦比亚内瓦的三级医院和一级创伤中心。与大多数LMIC医院一样，NUH没有创伤信息数据系统。因此，我们采用了一个行政电子数据库，以获取2010年8月至2012年6月期间在急诊科（艾德）住院或死亡的成人患者的临床相关信息，这些患者的国际疾病分类第10版（ICD-10）诊断表明创伤（S 00-Y 98）。在这两组中比较STP中推荐的干预措施。还检查了住院时间（LOS）和死亡率。共纳入4，324例患者，其中2，457例处于方案前阶段，1，867例处于方案后阶段。几种干预措施的使用增加：艾德中的血液制品输注（1.0 vs. 2.7%; p < 0.001），水肿患者使用高渗液体（3.2 vs. 8.9%; p < 0.001），放置Foley导管（11.1 vs. 13.8%; p = 0.007），动脉血气分析（16.6%对26.4%; p < 0.001），破伤风疫苗接种（19.3 vs. 26.0%; p < 0.001），放置多根大口径外周导管（29.5 vs. 34.7%; p < 0.001）、预防性抗生素（34.9 vs. 38.0%; p = 0.035）和使用镇痛药（64.5 vs. 68.0%; p = 0.016）。其他干预措施也呈上升趋势。手术和非手术患者的住院时间（LOS）均缩短（手术13.4 vs. 11.8天; p = 0.017;非手术4.4 vs. 3.8天; p = 0.059）。创伤患者的全因死亡率下降（3.9 vs. 2.9%; p = 0.088）。LMIC中大学医院的STP机构增加了重要干预措施的使用，同时降低了全因创伤患者的总体LOS。
Standardized trauma protocols (STPs) have reduced morbidity and mortality in mature trauma systems. Most hospitals in low- and middle-income countries (LMICs) have not yet implemented such protocols, often due to financial and logistic limitations. We report preliminary findings from a trauma quality improvement (QI) initiative, using and evaluating the impact of a low-cost STP in an LMIC university hospital.We developed an STP based on generally accepted best practices and damage control resuscitation. It was designed for the resources available at the test institution. The Neiva University Hospital (NUH) is a tertiary care hospital and level I trauma center in Neiva, Colombia. As in most LMIC hospitals, there was no trauma information data system at NUH. Therefore, we adapted an administrative electronic database to capture clinically relevant information of adult patients who were hospitalized or died in the emergency department (ED) between August 2010 and June 2012 with an International Classification of Diseases, 10th revision (ICD-10) diagnoses indicating trauma (S00-Y98). Interventions that were recommended in the STP were compared in these two groups. Length of hospital stay (LOS) and mortality were also examined.A total of 4,324 patients were included, of whom, 2,457 patients were in the pre-protocol period and 1,867 were in the post-protocol period. The use of several interventions increased: blood product transfusions in the ED (1.0 vs. 2.7 %; p < 0.001), use of hypertonic fluids in hypotensive patients (3.2 vs. 8.9 %; p < 0.001), placement of Foley catheters (11.1 vs. 13.8 %; p = 0.007), arterial blood gas draws (16.6 vs. 26.4 %; p < 0.001), tetanus vaccinations (19.3 vs. 26.0 %; p < 0.001), placement of multiple large bore peripheral catheters (29.5 vs. 34.7 %; p < 0.001), prophylactic antibiotics (34.9 vs. 38.0 %; p = 0.035), and the use of analgesics (64.5 vs. 68.0 %; p = 0.016). Other interventions also trended upwards. Length of stay (LOS) decreased for both surgical and non-surgical patients (surgical 13.4 vs. 11.8 days; p = 0.017; non-surgical 4.4 vs. 3.8 days; p = 0.059). All-cause mortality of trauma patients decreased (3.9 vs. 2.9 %; p = 0.088).The institution of an STP at a university hospital in an LMIC has increased the use of vital interventions while decreasing overall LOS for all-cause trauma patients.