Structured approach with primary and secondary survey for major trauma care: an overview of reviews.

IF 6 1区 医学 Q1 EMERGENCY MEDICINE
Silvia Gianola, Silvia Bargeri, Annalisa Biffi, Stefania Cimbanassi, Daniela D'Angelo, Daniela Coclite, Gabriella Facchinetti, Alice Josephine Fauci, Carla Ferrara, Marco Di Nitto, Antonello Napoletano, Ornella Punzo, Katya Ranzato, Alina Tratsevich, Primiano Iannone, Greta Castellini, Osvaldo Chiara
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引用次数: 1

Abstract

Background: A structured approach involves systematic management of trauma patients. We aim to conduct an overview of reviews about the clinical efficacy and safety of structured approach (i.e., primary and secondary survey) by guideline checklist compared to non-structured approach (i.e. clinical examination); moreover, routine screening whole-body computer tomography (WBCT) was compared to non-routine WBCT in patients with suspected major trauma.

Methods: We systematically searched MEDLINE (PubMed), EMBASE and Cochrane Database of Systematic Reviews up to 3 May 2022. Systematic reviews (SRs) that investigated the use of a structured approach compared to a non-structured approach were eligible. Two authors independently extracted data, managed the overlapping of primary studies belonging to the included SRs and calculated the corrected covered area (CCA). The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.

Results: We included nine SRs investigating two comparisons in stable trauma patients: structured approach vs non-structured approach (n = 1) and routine WBCT vs non-routine WBCT (n = 8). The overlap of included primary studies was generally high across outcomes (CCA ranged between 20.85 and 42.86%) with some discrepancies in the directions of effects across reviews. The application of a structured approach by checklist may improve adherence to guidelines (e.g. Advanced Trauma Life Support) during resuscitation and might lead to a reduction in mortality among severely injured patients as compared to clinical examination (Adjusted OR 0.51; 95% CI 0.30-0.89; p = 0.018; low certainty of evidence). The use of routine WBCT seems to offer little to no effects in reducing mortality and time spent in emergency room or department, whereas non-routine WBCT seems to offer little to no effects in reducing radiation dose, intensive care unit length of stay (LOS) and hospital LOS (low-to-moderate certainty of evidence).

Conclusions: The application of structured approach by checklist during trauma resuscitation may improve patient- and process-related outcomes. Including non-routine WBCT seems to offer the best trade-offs between benefits and harm. Clinicians should consider these findings in the light of their clinical context, the volume of patients in their facilities, the need for time management, and costs.

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结构方法与主要创伤护理的初级和二级调查:综述综述。
背景:一种结构化的方法涉及对创伤患者的系统管理。我们的目标是通过指南清单比较结构化方法(即一次和二次调查)与非结构化方法(即临床检查)的临床疗效和安全性;此外,对怀疑有重大创伤的患者进行常规筛查全身计算机断层扫描(WBCT)与非常规筛查全身计算机断层扫描(WBCT)的比较。方法:系统检索截至2022年5月3日的MEDLINE (PubMed)、EMBASE和Cochrane系统评价数据库。调查结构化方法与非结构化方法的使用情况的系统评价(SRs)是合格的。两位作者独立提取数据,管理纳入SRs的主要研究的重叠,并计算校正覆盖面积(CCA)。证据的确定性采用分级建议评估、发展和评价(GRADE)方法进行评估。结果:我们纳入了9例SRs,研究了稳定创伤患者的两种比较:结构化入路与非结构化入路(n = 1)和常规WBCT与非常规WBCT (n = 8)。纳入的主要研究在不同结局之间的重叠程度普遍较高(CCA范围在20.85 - 42.86%之间),但在不同综述的效应方向上存在一些差异。应用检查表的结构化方法可以提高复苏过程中对指南的依从性(如高级创伤生命支持),与临床检查相比,可能导致严重受伤患者死亡率降低(调整OR 0.51;95% ci 0.30-0.89;p = 0.018;证据的低确定性)。常规WBCT的使用似乎对降低死亡率和在急诊室或科室花费的时间几乎没有影响,而非常规WBCT在降低辐射剂量、重症监护病房住院时间(LOS)和医院LOS(低至中等证据确定性)方面似乎几乎没有影响。结论:在创伤复苏中应用结构化的检查表方法可以改善患者和过程相关的结果。包括非常规的WBCT似乎在利与弊之间提供了最好的权衡。临床医生应该根据他们的临床背景、医院的病人数量、时间管理的需要和成本来考虑这些发现。
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来源期刊
World Journal of Emergency Surgery
World Journal of Emergency Surgery EMERGENCY MEDICINE-SURGERY
CiteScore
14.50
自引率
5.00%
发文量
60
审稿时长
10 weeks
期刊介绍: The World Journal of Emergency Surgery is an open access, peer-reviewed journal covering all facets of clinical and basic research in traumatic and non-traumatic emergency surgery and related fields. Topics include emergency surgery, acute care surgery, trauma surgery, intensive care, trauma management, and resuscitation, among others.
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