A randomised controlled trial of verbal guidance versus verbal guidance supplemented by a photographic aid for bystander identification of intramuscular tranexamic acid injection sites in a simulated road injury scenario.

IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE
Tim Nutbeam, Emily Foote, Lauren R Rodgers, Jessica Thomas-Mourne, Rob Fenwick
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引用次数: 0

Abstract

Background: Non-compressible haemorrhage is a leading cause of preventable death following road injury. Tranexamic acid (TXA), when administered early, improves survival. Intramuscular (IM) administration offers a feasible route for early administration by lay bystanders. However, the ability of bystanders to correctly identify safe IM injection sites remains unclear. This study aimed to evaluate whether verbal guidance supplemented by a photographic aid improves the accuracy of site identification in a simulated road injury scenario.

Methods: In this randomised controlled trial, 64 lay participants were recruited on a university campus and randomised to receive either (1) verbal guidance alone or (2) verbal guidance plus photographic aid to locate the deltoid injection site on a simulated injured person. Site identification was assessed via sticker placement, and three expert raters with diverse medical backgrounds independently reviewed standardised photographs to determine site safety using a majority agreement rule. The primary outcome was safe site identification. A binomial generalised linear model assessed the association between intervention group and correct site identification. Inter-rater reliability was measured using Fleiss' Kappa.

Results: Participants in the verbal guidance plus photographic aid group were significantly more likely to identify a safe injection site compared to those receiving verbal guidance alone (87.5% vs. 62.5%; OR 4.67, 95% CI 1.33, 19.92, p = 0.03). The presence of concerns regarding site safety was also significantly lower in the photo and verbal group (18.8% vs. 53.1%, p = 0.002). No significant associations were found between accuracy and participant age, gender, prior training, or confidence.

Conclusions: Supplementing verbal guidance with a photographic aid significantly improves bystander accuracy in identifying safe IM TXA injection sites in a simulated setting. This finding supports the potential integration of visual aids into emergency dispatch protocols to enhance early haemorrhage control in trauma care. Further research is needed to assess real-world application and impact.

Clinical trial number: ISRCTN Registry: ISRCTN41280918.

Trial registration: ISRCTN Registry: ISRCTN41280918, 08/08/2025 Retrospectively registered.

一项随机对照试验,在模拟道路伤害情景中,口头指导与口头指导辅以摄影辅助的旁观者识别肌内氨甲环酸注射部位。
背景:不可压缩性出血是道路伤害后可预防死亡的主要原因。早期使用氨甲环酸(TXA)可提高生存率。肌内给药为外行人早期给药提供了一种可行的途径。然而,旁观者正确识别安全注射部位的能力仍不清楚。本研究旨在评估在模拟道路伤害场景中,辅以摄影辅助的口头指导是否能提高现场识别的准确性。方法:在这项随机对照试验中,在一所大学校园招募了64名非专业参与者,并随机接受(1)单独的口头指导或(2)口头指导加摄影辅助来定位模拟伤者的三角肌注射部位。现场鉴定通过贴贴进行评估,三名具有不同医学背景的专家评分员独立审查标准化照片,以使用多数同意规则确定现场安全性。主要结果是安全地点的确定。二项广义线性模型评估干预组与正确部位识别之间的关系。评估者间信度采用Fleiss’Kappa测量。结果:与单独接受口头指导的参与者相比,口头指导加摄影辅助组的参与者更容易识别安全注射部位(87.5% vs. 62.5%; OR 4.67, 95% CI 1.33, 19.92, p = 0.03)。对现场安全的担忧在照片组和语言组中也明显较低(18.8%比53.1%,p = 0.002)。准确性与参与者年龄、性别、先前培训或信心之间没有显著关联。结论:在模拟环境中,辅以摄影辅助的口头指导显著提高了旁观者识别安全的IM TXA注射部位的准确性。这一发现支持将视觉辅助工具整合到紧急调度方案中,以加强创伤护理中的早期出血控制。需要进一步的研究来评估现实世界的应用和影响。临床试验号:ISRCTN注册:ISRCTN41280918。试验注册:ISRCTN注册:ISRCTN41280918, 08/08/2025回顾性注册。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Emergency Medicine
BMC Emergency Medicine Medicine-Emergency Medicine
CiteScore
3.50
自引率
8.00%
发文量
178
审稿时长
29 weeks
期刊介绍: BMC Emergency Medicine is an open access, peer-reviewed journal that considers articles on all urgent and emergency aspects of medicine, in both practice and basic research. In addition, the journal covers aspects of disaster medicine and medicine in special locations, such as conflict areas and military medicine, together with articles concerning healthcare services in the emergency departments.
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