Asanthi Ratnasekera, Sirivan S Seng, Marina Ciarmella, Alexandria Gallagher, Kelly Poirier, Eric Shea Harding, Elliott R Haut, William Geerts, Patrick Murphy
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Therefore, we conducted a systematic review and meta-analysis of published literature on active implementation strategies for VTE prophylaxis administration in hospitalized trauma patients and the impact on VTE events.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was performed in adult hospitalized trauma patients to assess if active VTE prevention implementation strategies change the proportion of patients who received VTE prophylaxis, VTE events, and adverse effects such as bleeding or heparin-induced thrombocytopenia as well as hospital length of stay and the cost of care. 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引用次数: 0
摘要
导言：静脉血栓栓塞症（VTE）预防策略在一些住院内科和外科病人中得到了充分研究。虽然 VTE 与创伤患者的死亡率和发病率息息相关，但在创伤中预防 VTE 的实施策略似乎证据有限。因此，我们对已发表的文献进行了系统回顾和荟萃分析，内容涉及住院创伤患者VTE预防管理的积极实施策略以及对VTE事件的影响：对成人住院创伤患者进行了系统回顾和荟萃分析，以评估积极的 VTE 预防策略是否会改变接受 VTE 预防的患者比例、VTE 事件、出血或肝素诱导的血小板减少症等不良反应以及住院时间和护理成本。一位学术医学图书管理员检索了Medline、Scopus和Web of Science，直至2022年12月：四项研究共纳入了1723名积极实施策略组（策略包括教育、提醒、人工和计算机警报、审计和反馈、预印医嘱和/或根本原因分析）和1324名无积极实施策略组（指南制定和传播）的患者。采用积极实施策略的患者接受 VTE 预防的比例更高（OR=2.94，95% CI (1.68 to 5.15)，p 结论：积极的实施策略似乎提高了重大创伤患者接受 VTE 预防的比例。需要在创伤领域开展进一步的实施研究，以确定有效、可持续的 VTE 预防策略，并评估出血和成本等次要结果：系统综述/总体分析，III 级：CRD42023390538。
Thromboprophylaxis in hospitalized trauma patients: a systematic review and meta-analysis of implementation strategies.
Introduction: Venous thromboembolism (VTE) prophylaxis implementation strategies are well-studied in some hospitalized medical and surgical patients. Although VTE is associated with substantial mortality and morbidity in trauma patients, implementation strategies for the prevention of VTE in trauma appear to be based on limited evidence. Therefore, we conducted a systematic review and meta-analysis of published literature on active implementation strategies for VTE prophylaxis administration in hospitalized trauma patients and the impact on VTE events.
Methods: A systematic review and meta-analysis was performed in adult hospitalized trauma patients to assess if active VTE prevention implementation strategies change the proportion of patients who received VTE prophylaxis, VTE events, and adverse effects such as bleeding or heparin-induced thrombocytopenia as well as hospital length of stay and the cost of care. An academic medical librarian searched Medline, Scopus, and Web of Science until December 2022.
Results: Four studies with a total of 1723 patients in the active implementation strategy group (strategies included education, reminders, human and computer alerts, audit and feedback, preprinted orders, and/or root cause analysis) and 1324 in the no active implementation strategy group (guideline creation and dissemination) were included in the analysis. A higher proportion of patients received VTE prophylaxis with an active implementation strategy (OR=2.94, 95% CI (1.68 to 5.15), p<0.01). No significant difference was found in VTE events. Quality was deemed to be low due to bias and inconsistency of studies.
Conclusions: Active implementation strategies appeared to improve the proportion of major trauma patients who received VTE prophylaxis. Further implementation studies are needed in trauma to determine effective, sustainable strategies for VTE prevention and to assess secondary outcomes such as bleeding and costs.
Level of evidence: Systematic review/meta-analysis, level III.
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