Courtney H Meyer, Mari Freedberg, Janelle Tanghal, Christine Castater, Crystal T Nguyen, Randi N Smith, Jason D Sciarretta, Jonathan Nguyen
{"title":"PIC 评分是否正确？对基于单一机构回顾性队列研究的改良 PIC 的评估。","authors":"Courtney H Meyer, Mari Freedberg, Janelle Tanghal, Christine Castater, Crystal T Nguyen, Randi N Smith, Jason D Sciarretta, Jonathan Nguyen","doi":"10.1016/j.injury.2024.111860","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>The Pain, Inspiratory effort, Cough score (PIC) has been developed and widely adopted to guide clinical prognostication for patients with chest wall injury. To date, the efficacy, accuracy, and safety of a PIC based triage system has not been validated. Therefore, this study sought to evaluate the use of a modified-PIC score to triage and down-grade trauma patients with chest wall injury at a single institution.</p><p><strong>Methods: </strong>A retrospective study was conducted at a large, Level I Trauma Center on patients with chest wall injuries admitted between 1/1/2018-10/31/20,222. On 12/1/2020, our institution implemented a modified-PIC triage tool including the PIC score, age, and severity of chest wall injury. The Pre-PIC (1/1/2018-11/20/2020) and Post-PIC (1/1/2021-10/31/2022) groups were composed based on admission date and outcomes between the two were compared.</p><p><strong>Results: </strong>2,627 patients comprised the Pre-PIC group and 2,212 patients comprised Post-PIC. The groups didn't differ significantly in demographics or mechanisms of injury except for COVID status. Post-intervention, a greater proportion of patients were triaged to the intermediate care unit instead of the ICU or floor. There were no significant differences in hospital length of stay (LOS), ventilator days, unplanned ICU admission, or mortality in Pre-PIC vs Post-PIC. ICU LOS, rates of ARDS, and cardiac arrest with return of spontaneous circulation (ROSC) were significantly lower in Post-PIC. Multivariable models demonstrated significantly lower ARDS rates and ICU free days. ICU LOS trended towards significance as well.</p><p><strong>Conclusions: </strong>This is the largest study, to date, evaluating the impact of a modified-PIC triage system on clinical outcomes. The results suggest a modified-PIC triage system may lead to decreased ICU days, ARDS rates, and rates of cardiac arrest w/ ROSC, potentially improving hospital resource allocation. Further prospective and multi-center studies are needed to validate our understanding on the impact of a chest wall scoring system on triage and outcomes.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Does PIC score pick correctly? Evaluation of a modified-PIC based admission a single institution retrospective cohort study.\",\"authors\":\"Courtney H Meyer, Mari Freedberg, Janelle Tanghal, Christine Castater, Crystal T Nguyen, Randi N Smith, Jason D Sciarretta, Jonathan Nguyen\",\"doi\":\"10.1016/j.injury.2024.111860\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>The Pain, Inspiratory effort, Cough score (PIC) has been developed and widely adopted to guide clinical prognostication for patients with chest wall injury. To date, the efficacy, accuracy, and safety of a PIC based triage system has not been validated. Therefore, this study sought to evaluate the use of a modified-PIC score to triage and down-grade trauma patients with chest wall injury at a single institution.</p><p><strong>Methods: </strong>A retrospective study was conducted at a large, Level I Trauma Center on patients with chest wall injuries admitted between 1/1/2018-10/31/20,222. On 12/1/2020, our institution implemented a modified-PIC triage tool including the PIC score, age, and severity of chest wall injury. The Pre-PIC (1/1/2018-11/20/2020) and Post-PIC (1/1/2021-10/31/2022) groups were composed based on admission date and outcomes between the two were compared.</p><p><strong>Results: </strong>2,627 patients comprised the Pre-PIC group and 2,212 patients comprised Post-PIC. The groups didn't differ significantly in demographics or mechanisms of injury except for COVID status. Post-intervention, a greater proportion of patients were triaged to the intermediate care unit instead of the ICU or floor. There were no significant differences in hospital length of stay (LOS), ventilator days, unplanned ICU admission, or mortality in Pre-PIC vs Post-PIC. ICU LOS, rates of ARDS, and cardiac arrest with return of spontaneous circulation (ROSC) were significantly lower in Post-PIC. Multivariable models demonstrated significantly lower ARDS rates and ICU free days. ICU LOS trended towards significance as well.</p><p><strong>Conclusions: </strong>This is the largest study, to date, evaluating the impact of a modified-PIC triage system on clinical outcomes. The results suggest a modified-PIC triage system may lead to decreased ICU days, ARDS rates, and rates of cardiac arrest w/ ROSC, potentially improving hospital resource allocation. Further prospective and multi-center studies are needed to validate our understanding on the impact of a chest wall scoring system on triage and outcomes.</p>\",\"PeriodicalId\":94042,\"journal\":{\"name\":\"Injury\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-09-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Injury\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/j.injury.2024.111860\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Injury","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.injury.2024.111860","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Does PIC score pick correctly? Evaluation of a modified-PIC based admission a single institution retrospective cohort study.
Introduction: The Pain, Inspiratory effort, Cough score (PIC) has been developed and widely adopted to guide clinical prognostication for patients with chest wall injury. To date, the efficacy, accuracy, and safety of a PIC based triage system has not been validated. Therefore, this study sought to evaluate the use of a modified-PIC score to triage and down-grade trauma patients with chest wall injury at a single institution.
Methods: A retrospective study was conducted at a large, Level I Trauma Center on patients with chest wall injuries admitted between 1/1/2018-10/31/20,222. On 12/1/2020, our institution implemented a modified-PIC triage tool including the PIC score, age, and severity of chest wall injury. The Pre-PIC (1/1/2018-11/20/2020) and Post-PIC (1/1/2021-10/31/2022) groups were composed based on admission date and outcomes between the two were compared.
Results: 2,627 patients comprised the Pre-PIC group and 2,212 patients comprised Post-PIC. The groups didn't differ significantly in demographics or mechanisms of injury except for COVID status. Post-intervention, a greater proportion of patients were triaged to the intermediate care unit instead of the ICU or floor. There were no significant differences in hospital length of stay (LOS), ventilator days, unplanned ICU admission, or mortality in Pre-PIC vs Post-PIC. ICU LOS, rates of ARDS, and cardiac arrest with return of spontaneous circulation (ROSC) were significantly lower in Post-PIC. Multivariable models demonstrated significantly lower ARDS rates and ICU free days. ICU LOS trended towards significance as well.
Conclusions: This is the largest study, to date, evaluating the impact of a modified-PIC triage system on clinical outcomes. The results suggest a modified-PIC triage system may lead to decreased ICU days, ARDS rates, and rates of cardiac arrest w/ ROSC, potentially improving hospital resource allocation. Further prospective and multi-center studies are needed to validate our understanding on the impact of a chest wall scoring system on triage and outcomes.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
