How trauma patients die in low resource settings: Identifying early targets for trauma quality improvement.
How trauma patients die in low resource settings: Identifying early targets for trauma quality improvement.
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创伤患者如何在资源匮乏的环境中死亡：确定创伤质量改善的早期目标。
DOI：
10.1097/ta.0000000000003768
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Juillard,Catherine
中科院分区：
文献类型：
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作者：
Christie,SAriane;Zheng,Dennis;Dissak-Delon,Fanny;Kinge,Thompson;Njock,Richard;Nkusu,Daniel;Tsiagadigui,Jean-Gustave;Mbianyor,Mbiarikai;Dicker,Rochelle;Chichom-Mefire,Alain;Juillard,Catherine
背景撒哈拉以南非洲的伤亡死亡人数是世界上最高的之一，但医院数据很少有足够的粒度来指导质量改进。我们分析了撒哈拉以南多中心前瞻性队列中死亡的创伤患者的临床护理模式，以确定创伤质量改善干预目标。方法包括2017至2019年间喀麦隆四家医院的院内创伤死亡病例。研究人员分析了有关患者人口统计、损伤特征和临床护理的创伤登记数据，以确定系统改进的机会。结果在9,423名创伤患者中，有236人死亡。总体而言，在急诊科死亡的患者中，83%的人生活在到达时(LOA)。在183名LOA患者中，30%的患者生命体征正常，但11%的患者没有生命体征，通常是因为缺乏设备(43%)。在格拉斯哥昏迷评分为9分的LOA患者中(56%)，很少接受神经外科会诊(15%)、放置C环(9%)或插管(1%)。最常见的原因是没有意识到这一点(66%)。63%的LOA患者出现气管偏曲、呼吸音不均匀或反常的胸部运动，但只有2名患者放置了胸管。80%的LOA患者存在低血压或活动性出血；其中96%的患者接受了晶体丸治疗，少数患者接受了输血(8%)、肢体损伤止血带放置(6%)或手术(4%)。结论喀麦隆创伤死亡患者的初步调查干预措施做得不够。早期处理颅脑损伤、失血性休克和胸壁创伤可降低创伤死亡率。
BACKGROUNDInjury deaths in sub-Saharan Africa are among the world's highest, but hospital data rarely have sufficient granularity to direct quality improvement. We analyzed clinical care patterns among trauma patients who died in a prospective, multicenter sub-Saharan cohort to pinpoint trauma quality improvement intervention targets.METHODSIn-hospital trauma deaths in four Cameroonian hospitals between 2017 and 2019 were included. Trauma registry data on patient demographics, injury characteristics, and clinical care were analyzed to identify opportunities for systems improvements.RESULTSAmong 9,423 trauma patients, there were 236 deaths. Overall, 83% of patients who died in the emergency department were living on arrival (LOA). Among 183 LOA patients, 30% presented with normal vital signs, but 11% had no vital signs taken, often because of lack of equipment (43%). Of LOA patients presenting with a Glasgow Coma Scale score of< 9 (56%), few received neurosurgery consults (15%), C-collar placement (9%), or intubation (1%). The most common reason for lack of c-collar placement was failure to recognize that it was indicated (66%). Tracheal deviation, unequal breath sounds, or paradoxical chest movement were present in 63% of LOA patients, but only two patients had chest tubes placed. Hypotension or active bleeding was present in 80% of LOA patients; while crystalloid bolus was given to 96% of these patients, few received transfusion (8%), tourniquet placement for extremity injury (6%), or an operation (4%).CONCLUSIONPrimary survey interventions are underperformed in trauma nonsurvivors in Cameroon. Protocolizing early treatment for head injury, hemorrhagic shock, and chest wall trauma could reduce trauma mortality.