Adherence to ATLS primary and secondary surveys during pediatric trauma resuscitation
Adherence to ATLS primary and secondary surveys during pediatric trauma resuscitation
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DOI：
10.1016/j.resuscitation.2011.10.032
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发表时间：
2013-01-01
期刊：
影响因子：
6.5
通讯作者：
Burd, Randall S.
中科院分区：
文献类型：
--
作者：
Carter, Elizabeth A.;Waterhouse, Lauren J.;Burd, Randall S.
研究目的：遵守高级创伤生命支持（ATLS）方案与改善受伤患者的管理相关。本研究的目的是确定延迟和遗漏的ATLS主要和次要调查任务的相关因素在一级儿科trauma center.Methods：视频记录复苏的237名受伤的患者< 18岁，在我们医院获得超过4个月的时间进行了评估，以评估完整性和及时性的基本任务的ATLS的主要和次要调查。进行多变量分析，以确定与ATLS性能下降相关的功能。结果：主要调查结果表明，烧伤患者与钝性损伤（RR = 1.72; 95%CI：1.26-2.35），并不经常在夜间轮班[11 PM-7 AM]（RR = 1.22; 95%CI：1.02-1.46）。二次调查结果在穿透性损伤患者中较少被描述（RR = 2.30; 95%CI：1.06-5.00）。在烧伤患者（HR = 0.69; 95%CI：0.48-0.98）和从另一家医院转移的患者中，主要调查结果的陈述时间延迟。完整性和及时性的ATLS任务的性能与年龄或损伤严重程度scores.Conclusions：损伤和医院因素的机制与不完整和延迟的主要和次要调查。解决与这些因素相关的ATLS依从性不足的干预措施可能会减少患者护理这一关键时期的错误。(C)2012爱思唯尔爱尔兰有限公司保留所有权利。
Study aim: Adherence to Advanced Trauma Life Support (ATLS) protocol has been associated with improved management of injured patients. The objective of this study is to determine factors associated with delayed and omitted ATLS primary and secondary survey tasks at a level 1 pediatric trauma center.Methods: Video recorded resuscitations of 237 injured patients < 18 years old obtained over a four month period at our hospital were evaluated to assess completeness and timeliness of essential tasks in the primary and secondary survey of ATLS. Multivariate analyses were performed to identify features associated with decreased ATLS performance.Results: Primary survey findings were stated less often in patients with burn injuries compared to those with blunt injuries (RR = 1.72; 95% CI: 1.26-2.35) and less often during the overnight shift [11 PM-7 AM] (RR = 1.22; 95% CI: 1.02-1.46). Secondary survey findings were verbalized less often in patients with penetrating injures (RR = 2.30; 95% CI: 1.06-5.00). Time to statement of primary surveys findings was delayed in patients with burn injuries (HR = 0.69; 95% CI: 0.48-0.98) and among those transferred from another hospital. Completeness and timeliness of ATLS task performance were not associated with age or injury severity score.Conclusions: Mechanism of injury and hospital factors are associated with incomplete and delayed primary and secondary surveys. Interventions that address deficient ATLS adherence related to these factors may lead to a reduction in errors during this critical period of patient care. (C) 2012 Elsevier Ireland Ltd. All rights reserved.