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 受伤是46岁以下人群最常见的死亡原因，受伤后出血是最常见的死亡原因。 是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。 出血以及药物和输血，以防止血液稀释。专门从事 治疗受伤有协议，药物，设备和临床工作人员提供一天24小时和七天 一周在专科医院接受治疗的伤者更有可能活下来。然而，有太多的 受伤的人，每年比可以在专科医院治疗，所以轻伤照顾， 医院不专门治疗受伤。严重受伤的人被送往不专门治疗 当专业医院距离太远时，或紧急医疗人员 低估了一个人的伤势。不专门治疗受伤的医院不参加 在正在进行的损伤临床试验、区域数据登记或国家质量改进计划中，以及作为 结果那里发生了什么导致人们流血致死是未知的。这个应用程序是长期的 目的提高创伤后出血救治的及时性。具体目标是：1） 了解如何受伤后出血是在医院管理，不专门治疗受伤; 2)找出病人得不到及时治疗的原因; 3）确定如何提高及时性， 治疗中心假设是，在非专科医院，出血治疗不规范 在治疗伤员方面，这导致了将伤员转送到专科医院的延误。识别 可修改的医疗保健系统、医院和患者因素可以为系统过程的设计提供信息， 首先在非专业中心迅速暂时稳定受伤人员的出血， 通过与各医院的关键利益攸关方接触，将其转移到专科医院。这将 确保受伤后流血的人在正确的时间和正确的地点得到护理。最终 在正确的时间进行正确的治疗将使人们最初被送往不专门治疗受伤的医院， 与那些被送往专科医院的人一样有机会活下来。作为职业发展奖， 培训计划将包括数据科学、系统工程和设计方面的培训。要学习的方法 将采用机器学习、故障模式、影响和危害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目前的实践管理受伤后出血， 以提高出血治疗的及时性，增强受伤伤员的健康。