Timeliness of Management of Trauma Related Hemorrhage and Trauma Related Coagulopathy

创伤相关出血和创伤相关凝血障碍的及时处理

• 批准号: 10203288
• 负责人: Anne M Stey
• 金额: $ 19.03万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10203288
• 关键词: Accident and Emergency department; Adherence; Age-Years; Algorithms; American; American College of Surgeons; Area; Bleeding time procedure; Blood; Blood Coagulation Disorders; Blood Pressure; Blood Transfusion; Caring; Cause of Death; Cessation of life; Chicago; Clinical; Clinical Data; Clinical Trials; Data; Data Science; Devices; Emergency Medical Technicians; Emergency medical service; Ensure; Failure; Future; Goals; Guidelines; Health; Healthcare Systems; Hemorrhage; Hemostatic Agents; Hospitals; Hour; Illinois; Injury; Intervention; Interventional radiology; K-Series Research Career Programs; Knowledge; Laboratories; Learning; Life; Machine Learning; Maps; Methods; Minor; Operative Surgical Procedures; Outcomes Research; Patient Care; Patient Transfer; Patient Triage; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Physiological; Practice Management; Procedures; Process; Protocols documentation; Provider; Randomized Controlled Trials; Research; Resources; Resuscitation; Special Hospitals; Standardization; System; Testing; Thinness; Time; Time Management; Training; Trauma; Trauma patient; Traumatic injury; Triage; United States; Work; blood product; clinical care; data modeling; data registry; design; engineering design; high risk; improved; injured; mortality; patient oriented; prevent; preventable death; programs; prototype; severe injury; standardized care; stroke patient; supervised learning; time use; trauma care; trauma centers; user centered design

PROJECT SUMMARY Injury is the most common cause of death in people younger than 46 years of age, and bleeding after injury is the most common cause of preventable death. Treatment of bleeding requires timely procedures to stop the bleeding as well as medications and blood transfusions to prevent blood thinning. Hospitals that specialize in treating injury have protocols, medications, devices and clinical staff available 24 hours a day and seven days a week. Injured people treated at specialized hospitals are more likely to live. However, there are far too many injured people every year than can be treated at specialized hospitals so minor injuries are cared for at hospitals not specialized in treating injuries. Severely injured people are taken to hospitals not specialized in treating injuries when specialized hospitals are too far away, or the emergency medical personnel underestimate how seriously injured someone is. Hospitals not specialized in treating injuries do not participate in ongoing injury clinical trials, regional data registries nor national quality improvement programs, and as a result what happens there that leads to people bleeding to death is unknown. This application's long-term objective is to improve the timeliness of treatment of bleeding after injury. The Specific Aims will be to: 1) understand how bleeding after injury is managed in hospitals that do and do not specialize in treating injuries; 2) identify the reasons patients do not get timely treatment; and3) determine how to improve the timeliness of treatment. The central hypothesis is that treatment of bleeding is not standardized in hospitals not specialized in treating injuries and leads to a delay in transferring injured people to specialized hospitals. Identifying modifiable healthcare system, hospital, and patient factors can inform the design of a systematic process to quickly temporarily stabalize bleeding of injured people initially at non-specialized centers then expedite transfer to specialized hospitals by engaging key stakeholders from across the spectrum of hospitals. This will ensure that people who are bleeding after injury are cared for at the right place at the right time. Ultimately, the right treatment at the right time will give people initially taken to hospitals not specialized in treating injuries the same chance at life as those taken to specialized hospitals. As a Career Development Award, the proposed training plan will include training in data science, systems engineering and design. The methods to be learned and employed will be machine learning, failure mode, effects and criticality analysis and user-centered design. The health relatedness of the project is to understand current practice management of bleeding after injury, in order to improve the timeliness of bleeding treatments to enhance the health of injured inviduals.

项目摘要 伤害是46岁以下的人中最常见的死亡原因，受伤后出血为 可预防死亡的最常见原因。出血的治疗需要及时的程序来阻止 出血以及输血，以防止血液稀疏。专门从事的医院 治疗伤害有协议，药物，设备和临床人员每天24小时可用 一个星期。在专业医院接受治疗的受伤人员更有可能生活。但是，有太多 每年受伤的人比在专业医院接受治疗，因此受到轻伤 医院不专门治疗伤害。严重受伤的人被带到不专门的医院 当专业医院太遥远或紧急医务人员时，治疗受伤 低估了某人严重受伤。不专门治疗伤害的医院不参加 在正在进行的伤害临床试验中，区域数据注册或国家质量改进计划以及作为 导致人们流血死亡的结果尚不清楚。该应用程序是长期的 目的是改善受伤后出血的及时性。具体目标是：1） 了解在受伤后的受伤后出血是如何在受伤治疗的医院中如何管理的； 2）确定患者无法及时治疗的原因； 3）确定如何提高及时性 治疗。中心假设是，在不专业的医院中，出血的治疗未标准化 在治疗伤害并导致将受伤的人转移到专业医院的过程中。识别 可修改的医疗保健系统，医院和患者因素可以告知系统过程的设计 迅速暂时稳定最初在非特殊中心的受伤人员出血，然后加快 通过从医院范围内吸引主要利益相关者，转移到专业医院。这会 确保在正确的时间在正确的位置照顾受伤后流血的人。最终， 在正确的时间进行正确的治疗将使最初被带到不专门治疗伤害的医院 人生的机会与专业医院的机会相同。作为职业发展奖，提议 培训计划将包括数据科学，系统工程和设计方面的培训。学习的方法 并使用的将是机器学习，故障模式，效果和批判性分析以及以用户为中心的设计。 该项目的健康相关性是了解受伤后出血的当前实践管理， 为了改善出血治疗的及时性，以增强受伤的不景气的健康。