Improving Acute Hypertension Management through Emergency Department Checklist

项目摘要 在发展中国家，大约有10亿高血压患者。这个可预防的风险 这一因素导致了1000多万人死亡，以及与心脏病发作、中风和 肾功能衰竭。急性高血压急症是一种特殊的紧急情况，患者在这种情况下 血压严重升高(收缩压≥180毫米汞柱或舒张压≥ 110毫米汞柱)，并有主要器官衰竭的证据，例如心脏、脑、肺或肾脏。约1% 高血压患者在他们的一生中可能会遭受这种情况。高血压的诊断 紧急情况需要仔细评估，包括血液化学测试和诊断成像 慎重治疗，避免血压骤降所造成的伤害。 在急诊科，患有急性重度高血压的患者比例可能高达 5%。这不是一个不必要的负担，特别是在发展中国家，那里的资源用于 治疗和医生培训是有限的。美国的一项研究表明，即使在发达国家，也只有6 高血压患者在急诊中接受了适当的终末器官损害检查的比例。 因此，发展中国家的情况可能要糟糕得多。美国急救学院 内科医生(ACEP)也指出，目前还没有基于证据的指南来治疗急性 急诊室中的严重高血压。 在最近的过去，在全球各地的紧急护理环境中实施了清单 展示了在特定条件下患者管理和结果的改进。我们建议 制定和评估针对低收入人群急性重症高血压急诊护理的清单 布景。这在过去没有尝试过，因此可能会导致新的做法改变 知识。我们提出了一项准实验性的前后干预研究，以评估 急诊检查清单改善急性重症高血压患者的管理和预后 巴基斯坦卡拉奇的部门。我们开发了一个针对突发事件信息的专用数据采集系统 短期和长期的护理和患者结果。这项研究可以解决知识需求 由ACEP确定，例如“什么是最佳管理…因为它与患者的预后有关？

Project Summary There are about 1 billion people living with hypertension in the developing countries. This preventable risk factor accounts for over 10 million deaths and a significant morbidity related to heart attacks, strokes, and renal failures. Acute hypertensive emergency is a specific emergency condition in which a patient presents with a severely elevated blood pressure (systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥ 110 mmHg) and has evidence of major organ failure, e.g., heart, brain, lungs, or kidneys. About 1% of hypertensive patients could suffer from this condition during their lifetime. The diagnosis of Hypertensive Emergency requires careful evaluation consisting of blood chemistry tests and diagnostic imaging as well as cautious treatment to avoid harm caused by the precipitous blood pressure drop. The proportion of patients with acute severe hypertension in an emergency department could be as high as five percent. This is not an inconsequent burden especially in the developing countries where resources for treatment and physician training are limited. A US study showed that even in the developed world, only six percent of hypertensive patients in the emergency received appropriate work-up for the end-organ damage. Hence, the situation in the developing country could be much worse. The American College of Emergency Physicians (ACEP) also noted that there are no evidence-based guidelines available for treating acute severe hypertension in the ED settings. In the recent past, the implementation of a checklist in the emergency care settings across the globe showed the improvements in patient management and outcomes in specific conditions. We propose to develop and evaluate a checklist specific to emergency care of acute severe hypertension in a low-income setting. This has not been attempted in the past, and hence may result in new, practice changing knowledge. We propose a quasi-experimental, before-after, intervention study is to assess whether a checklist improves management and outcomes in patients of acute severe hypertension in an emergency department in Karachi, Pakistan. We develop a specific data capture system for information on emergency care and patient outcomes in short- and long-terms. The study may address the knowledge needs identified by ACEP such as “what is the optimal management …as it related to patient outcomes?”