当前的研究探讨了13年来五个领域的临床实践指南(CPG)发布后,战斗伤亡护理的应用趋势。
以色列国防军创伤登记处用于评估以下五个领域的实践和对指南的遵守情况:(a)晶体输血,(b)氨甲环酸的使用,(c)冻干血浆的使用,(d)胸部减压,(e)气道管理。所有在2006年1月至2018年12月期间受伤的患者均纳入分析。每月使用线性回归分析和呈现趋势,并使用Chow检验进行比较。
输注的平均±SD晶体体积从2006年的1,179±653mL下降到2018年的466±202mL(B=0.016,0.006-0.044)。在更严格的指南公布后,接受氨甲环酸治疗适应症的患者比例从8%(2,979例患者中的238例)下降到2.5%(2,356例患者中的60例)。指定伤亡人数中的冻干血浆给药从2013年的12.5%上升到2018年的48%(B=1.63,1.3-2.05)。在2012年发布新的CPG后,接受胸部减压的总伤亡人数比例从1%(6,036人伤亡中的61人)上升到1.5%(10,493人伤亡中的155人)(p=0.013)。在2012年之前(B=0.987,0.953-1.02)或之后(B=10.2,0.996-1.05)插管率没有显着趋势。
某些方面显示了响应新CPG的预期趋势;在其他方面,最初的改善是实现的,但随后是停滞。在一些医疗方面,观察到完全出乎意料和不期望的趋势。CPG的每一次更改和更新都应基于可靠的数据。必须仔细监测每项变化的影响,以确保充分遵守救生准则。
流行病学研究,四级。
The current study explores the trends in the application of combat casualty care following the publication of clinical practice
guidelines (CPGs) in five domains for 13 years.
The Israel Defense Forces Trauma Registry was used to assess practice and adherence to
guidelines in five domains: (a) crystalloid transfusions, (b) tranexamic acid use, (c) freeze-dried
plasma use, (d) chest decompression, and (e) airway management. All patients injured between January 2006 and December 2018 were included in the analysis. Trends were analyzed and presented monthly using linear regression and were compared using the Chow test.
The mean ± SD crystalloid volume transfused decreased from 1,179 ± 653 mL in 2006 to 466 ± 202 mL in 2018 (B = 0.016, 0.006-0.044). The proportion of patients with an indication treated with tranexamic acid dropped from 8% (238 of 2,979 patients) to 2.5% (60 of 2,356 patients) following the stricter
guideline\'s publication. Freeze-dried
plasma administration in indicated casualties rose from 12.5% in 2013 to 48% in 2018 (B = 1.63, 1.3-2.05). The overall proportion of casualties undergoing chest decompression rose from 1% (61 of 6,036 casualties) to 1.5% (155 of 10,493 casualties) following the release of a new CPG in 2012 (p = 0.013). There were no significant trends in intubation ratios before (B = 0.987, 0.953-1.02) or after 2012 (B = 10.2, 0.996-1.05).
Some aspects demonstrate the desired trends in response to new CPGs; in others, initial improvement is achieved but followed by stagnation. In some medical care aspects, completely unexpected and undesirable trends are observed. Every change and update in CPGs should be based on reliable data. The effect of every change must be monitored carefully to ensure adequate adherence to lifesaving guidelines.
Epidemiological study, level IV.