Journal of Emergency Nursing最新文献_第9页

The Mental Health of Emergency Nurses Exposed to Unexpected Death: An Integrative Review 意外死亡急诊护士的心理健康：一项综合评价。

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jen.2025.08.006

Austin DesJardin MSN, RN, CNE

Background

Emergency nurses face high-intensity situations that heighten their risk of mental health concerns, including compassion fatigue and post-traumatic stress symptoms. They report significantly higher levels of depression, anxiety, and secondary stress syndrome than other health care workers, which can negatively affect their well-being and patient care, leading to increased burnout and medical errors. This integrative review aimed to examine the mental health concerns of emergency nurses who care for patients who die unexpectedly.

Methods

This integrative review followed Whittemore and Knafl’s 5-step framework. A narrative synthesis was then completed, and data were analyzed using the Mixed Methods Appraisal Tool to mitigate biases. Four databases were systematically searched with specified search terms and without date restrictions.

Results

Fifteen studies were included, focusing on clinical events such as traumas, gunshot wounds, and motor vehicle accidents. The themes identified throughout the studies included coping mechanisms, end-of-life care education, and peer and managerial support. Symptoms reported by nurses included avoidance, substance abuse, and sleep disturbances.

Conclusion

Emergency nurses are vulnerable to the psychological impact of unexpected or traumatic deaths, increasing their risk of mental health concerns that affect their own health and patient outcomes. There is a need for intervention studies to address these issues and improve outcomes for nurses facing unexpected death.

背景：急诊护士面临高强度的情况，这增加了他们心理健康问题的风险，包括同情疲劳和创伤后应激症状。他们报告的抑郁、焦虑和继发性压力综合症的水平明显高于其他医护人员，这可能会对他们的健康和病人护理产生负面影响，导致倦怠和医疗差错的增加。本综合综述旨在检查急诊护士的心理健康问题谁照顾意外死亡的病人。方法：本综合综述遵循Whittemore和Knafl的五步框架。然后完成叙述综合，并使用混合方法评估工具分析数据以减轻偏见。系统地检索了四个数据库，并指定了检索条件，没有日期限制。结果：纳入了15项研究，重点关注临床事件，如创伤、枪伤和机动车事故。整个研究确定的主题包括应对机制、临终关怀教育、同伴和管理支持。护士报告的症状包括逃避、药物滥用和睡眠障碍。结论：急诊护士容易受到意外死亡或创伤性死亡的心理影响，增加了其心理健康问题的风险，从而影响其自身健康和患者预后。有必要进行干预研究，以解决这些问题，并改善护士面临意外死亡的结果。

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引用次数: 0

Evaluation of Nurse-Initiated X-Ray Protocols in Emergency Department Trauma Care 急诊创伤护理中护士主动x射线方案的评价

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jen.2025.07.006

Brijesh Sathian PhD, Javed Iqbal RN, MHA, Ashfaq Ahmad MBBS

引用次数: 0

Iatrogenic Bladder Rupture After Insertion of a Urinary Catheter in a Patient With Bladder Cancer: A Case Report 膀胱癌患者置管后医源性膀胱破裂1例报告。

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jen.2025.05.011

Sangun Nah MD, Sungwoo Choi MD, Woong Bin Kim MD, Sangsoo Han MD

Background

Iatrogenic bladder rupture is a rare but potentially life-threatening complication. Bladder rupture resulting from the insertion of a urinary catheter is exceedingly uncommon. Here, we report a case of bladder rupture after urinary catheter insertion in a patient with bladder cancer.

Case Presentation

An 80-year-old woman presented to the emergency department with fever, flank pain, and difficulty urinating. Her medical history included bladder cancer and neurogenic bladder. A urinary catheter had been placed owing to recent worsening of bladder function and had been maintained for 10 days. It was removed at an outpatient urology clinic the day before her emergency department visit to prevent a urinary tract infection. However, due to urinary retention, the urinary catheter was reinserted in the emergency department. After insertion, she complained of acute abdominal pain. Computed tomography revealed an intraperitoneal bladder rupture, with the urinary catheter positioned extraluminally through the bladder dome. The catheter was repositioned under ultrasound guidance, and conservative management with broad-spectrum antibiotics was initiated. The patient recovered well and was discharged without complications after 3 weeks.

Discussion

Urinary catheterization in patients at high risk of bladder rupture should be performed with careful technique, and the use of ultrasound guidance may be considered to minimize the risk of injury and ensure proper catheter placement.

背景：医源性膀胱破裂是一种罕见但可能危及生命的并发症。由于插入导尿管导致膀胱破裂是非常罕见的。在此，我们报告一例膀胱癌患者导尿管插入后膀胱破裂。病例介绍：一名80岁妇女因发烧、腹部疼痛和排尿困难而就诊于急诊科。病史包括膀胱癌和神经源性膀胱。由于最近膀胱功能恶化，放置了导尿管，并维持了10天。在她去急诊科的前一天，为了防止尿路感染，医生在门诊泌尿科把它取了下来。然而，由于尿潴留，在急诊科重新插入导尿管。插入后，她主诉急性腹痛。计算机断层扫描显示腹膜内膀胱破裂，导尿管放置在膀胱穹窿外。在超声引导下重新放置导管，并开始使用广谱抗生素进行保守治疗。3周后患者恢复良好，无并发症出院。讨论：膀胱破裂高危患者导尿应谨慎操作，并可考虑使用超声引导，以尽量减少损伤风险，并确保正确放置导尿管。

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引用次数: 0

Development and Psychometric Evaluation of the Emergency Nurses’ Subjective Well-Being at Workplace Instrument (EN-SUWIS): A Study Protocol 急诊护士工作场所主观幸福感量表（EN-SUWIS）的开发与心理测量评估：一个研究方案。

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jen.2025.05.010

Suis Galischa Wati BN, RN, MN, Syahirul Alim PhD, BN, RN, MSc, Christantie Effendy PhD, BN, RN, MPH

Introduction

The well-being of emergency nurses in the workplace has a significant impact on their performance and patient care. Measuring emergency nurses’ subjective well-being is necessary to identify their perceived well-being and areas for improvement. However, none of the existing instruments are specifically designed to measure emergency nurses’ subjective well-being, making measurement of it less representative and accurate than with an appropriate instrument. Given that the emergency department has unique characteristics different from other units, the development of the Emergency Nurses’ Subjective Well-Being at Workplace Instrument is needed. This protocol outlines the stages of development and testing to obtain a valid and reliable instrument.

Methods

The exploratory sequential mixed-methods design will be used in instrument development, which consists of 3 stages. The first stage will involve qualitative research exploring emergency nurses’ experiences and perspectives on workplace well-being and a literature review to identify relevant concepts and theoretical frameworks. The second stage will focus on generating the instrument’s items, and the final stage will involve psychometric testing to assess the instrument’s content validity, face validity, construct validity, internal consistency, and test–retest reliability. This protocol received ethical approval with record number KE/FK/0389/EC/2025.

Results

This study is expected to produce a specific, valid, and reliable instrument that can measure emergency nurses’ subjective well-being comprehensively and accurately.

Discussion

The development of the Emergency Nurses’ Subjective Well-Being at Workplace Instrument is essential to assist nursing managers and hospital stakeholders in understanding and identifying areas for improvement and formulating appropriate interventions to enhance emergency nurses’ subjective well-being, thus improving the overall health care quality.

工作场所急诊护士的幸福感对他们的表现和病人护理有重大影响。测量急诊护士的主观幸福感是必要的，以确定他们的感知幸福感和改进的领域。然而，没有一个现有的工具是专门设计来衡量急诊护士的主观幸福感，使其测量的代表性和准确性不如一个适当的工具。鉴于急诊科具有不同于其他科室的独特特点，需要编制《急诊护士工作场所主观幸福感量表》。本协议概述了开发和测试阶段，以获得有效和可靠的仪器。方法：采用探索性顺序混合方法设计进行仪器研制，共分为3个阶段。第一阶段将包括定性研究，探索急诊护士对工作场所幸福感的经验和观点，并进行文献综述，以确定相关概念和理论框架。第二阶段将侧重于生成工具的项目，最后阶段将涉及心理测量测试，以评估工具的内容效度，面效度，结构效度，内部一致性和重测信度。该方案获得了伦理批准，记录号为KE/FK/0389/EC/2025。结果：本研究期望能产生一个具体、有效、可靠的工具，能够全面、准确地测量急诊护士的主观幸福感。讨论：急诊护士工作场所主观幸福感量表的开发对于帮助护理管理者和医院利益相关者了解和确定需要改进的领域并制定适当的干预措施以提高急诊护士的主观幸福感，从而提高整体医疗质量至关重要。

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引用次数: 0

The Impact of Emergency Department Geriatric Nurse Practitioners on Patient Length of Stay 急诊科老年护士从业人员对病人住院时间的影响。

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jen.2025.06.003

Kenneth M. Forte DNP, APRN, Andriana M. Foiles Sifuentes PhD, MS, MA, Adam Chess MA, MPH, Cheryl Green PhD, DNP, RN, LCSW, CNE, CNL, Anna Clabby MSN, APRN

Introduction

Limited research exists that examines the impact of geriatric-focused nurse practitioners practicing within United States emergency departments on the reduction of inpatient admission length of stay for older patients. This represents a significant gap in the provision of care. Our study aimed to assess the efficacy of geriatric-focused nurse practitioners’ integration into an emergency department setting and the subsequent effect on the length of stay of inpatient hospital admissions.

Methods

We conducted a retrospective analysis of medical records for patients aged ≥65 years from a large, private, not-for-profit, urban hospital emergency department. Data on ED encounters were collected from the year 2023 and aggregated based on patients’ age, inpatient hospital admission, and whether they were assigned to a geriatric-focused nurse practitioner while in the emergency department. To investigate the differences in inpatient admission length of stay between geriatric patients assessed and treated by geriatric-focused nurse practitioners and those who were not, we needed to establish confounders that could contribute to the patient’s length of stay. We conducted a causal effect identification model and identified 4 confounding variables, which were adjusted for during our analysis.

Results

Findings indicated that patients receiving consultations by geriatric-focused nurse practitioners in the emergency department had a statistically significant reduction in their inpatient length of stay. The unadjusted mean admission length of stay reduced to 5.86 days from 7.28 days, with an unadjusted median reduced to 4.63 days from 4.95 days. We used a multivariable linear regression model using log-transformed length of stay adjusted for confusion assessment method score, mobility score, polypharmacy status, and triage acuity. Data showed that geriatric-focused nurse practitioners’ consultations with older patients within the emergency department resulted in a 10.3% reduction in admission length of stay (95% CI, 1.95-17.93).

Discussion

Geriatric-focused nurse practitioners in the emergency department led to a substantial decrease in inpatient lengths of stay.

引言：有限的研究调查了美国急诊科以老年医学为重点的执业护士对减少老年患者住院时间的影响。这表明在提供护理方面存在重大差距。我们的研究旨在评估老年护理从业者融入急诊科环境的效果，以及随后对住院病人住院时间的影响。方法：我们对一家大型、私立、非营利性城市医院急诊科年龄≥65岁患者的病历进行回顾性分析。从2023年开始收集急诊科遭遇的数据，并根据患者的年龄、住院情况以及他们在急诊科时是否被分配给以老年为重点的执业护士进行汇总。为了调查由以老年为重点的执业护士评估和治疗的老年患者与那些没有接受评估和治疗的老年患者住院时间的差异，我们需要建立可能影响患者住院时间的混杂因素。我们进行了因果关系识别模型，并确定了4个混杂变量，并在分析过程中进行了调整。结果：研究结果表明，在急诊科接受以老年医学为重点的执业护士会诊的患者，其住院时间在统计上显着减少。未经调整的平均住院时间由7.28天减少至5.86天，未经调整的中位数由4.95天减少至4.63天。我们使用了一个多变量线性回归模型，该模型使用对数转换的住院时间，调整了混淆评估方法评分、流动性评分、多药状态和分诊灵敏度。数据显示，以老年病学为重点的执业护士在急诊科对老年患者进行咨询，可使住院时间缩短10.3% （95% CI, 1.95-17.93）。讨论：急诊科以老年病学为重点的护士从业人员导致住院时间的大幅减少。

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引用次数: 0

Understanding the Lived Experiences of Nurses and Care Attendants in a Pediatric Hospital Who Experience Patient Aggression 了解儿科医院护士和护理人员的生活经历谁经历了病人的攻击。

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jen.2025.06.010

Stephanie Benning MSN, APRN, PCNS-BC, CPN, Marlene Walden PhD, APRN, NNP-BC, CCNS, FAAN, Amy Ramick DNP, RN, ACNS-BC, NPD-BC, Austin Lovenstein MBA, MA, BS, CRS, Greg Adams LCSW, ACSW, FT, Amy Decker MS, BSN, LAC, LAMFT, CPN, VA-BC

Introduction

This phenomenological research study aimed to describe the lived experiences of nurses and care attendants in a pediatric hospital who experience patient aggression.

Methods

Purposive sampling was used to identify nurses and care attendants who worked in the emergency department and a medical-surgical unit. Interviews were conducted, and Husserl’s descriptive (eidetic) phenomenology was used to explore, analyze, and describe the lived experiences of staff who experience patient aggression. Data were audited according to the 7 steps of Colaizzi’s method for descriptive research.

Results

Eleven participants shared their lived experiences, which resulted in 6 primary themes: (1) complex phenomenon of pediatric patient aggression, (2) physical and psychological impact of patient aggression on staff, (3) perceptions of acceptance of patient aggression, (4) staff’s perception of efforts to address patient aggression, (5) influence of education and experience on the management of patient aggression, and (6) organizational implications of managing patient aggression.

Discussion

Patient aggression has a significant physical and psychological impact on nurses and care attendants in pediatric hospital settings. The complexity of this type of aggression requires organizations to have an intentional and comprehensive approach to ensure patient and staff safety. Effectively addressing patient aggression requires a comprehensive approach that includes collaboration among community and provider stakeholders, engaged and supportive leaders, effective policies, staff experienced in de-escalation, education that translates into clinical practice, and purposeful strategies to address perceptions of acceptance of patient aggression.

前言：本研究旨在描述儿科医院护士及护理员在面对病人攻击时的生活经验。方法：采用有目的的抽样方法，对在急诊科和内科外科工作的护士和护理人员进行调查。我们进行了访谈，并使用胡塞尔的描述现象学（eidetic）来探索、分析和描述遭受患者攻击的员工的生活经历。根据Colaizzi描述性研究方法的7个步骤对数据进行审计。结果：11位参与者分享了他们的生活经历，形成了6个主要主题：(1)儿科患者攻击的复杂现象；(2)患者攻击对工作人员的生理和心理影响；(3)对患者攻击的接受程度的看法；(4)工作人员对应对患者攻击的努力的看法；(5)教育和经验对患者攻击管理的影响；(6)管理患者攻击的组织意义。讨论：患者攻击对儿科医院的护士和护理人员有显著的生理和心理影响。这种类型攻击的复杂性要求组织有一个有意识的和全面的方法来确保病人和工作人员的安全。有效解决患者攻击需要一种全面的方法，包括社区和提供者利益相关者之间的合作，参与和支持的领导者，有效的政策，在降级方面经验丰富的工作人员，转化为临床实践的教育，以及有目的的策略，以解决接受患者攻击的看法。

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引用次数: 0

Use of the Dynamic Appraisal of Situational Aggression Tool to Predict Violence in the Emergency Department and Other Acute Care Settings 使用情境攻击的动态评估工具来预测急诊科和其他急症护理环境中的暴力行为。

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jen.2025.07.003

Kiran McCloskey PhD, Gari Leigh Adams DNP, Paula Bird DNP, Keith Murphy PhD

Introduction

Few violence risk assessment instruments have been validated for use among the general population in the emergency department or subsequent acute care settings. This study evaluated the predictive validity of the Dynamic Appraisal of Situational Aggression tool for use with the general population in these settings.

Method

The Dynamic Appraisal of Situational Aggression was implemented for all emergency department and acute care admissions within a large health care system in North Carolina in July 2022. A retrospective analysis was conducted with all encounters with individuals aged 18 years or older who were discharged from March 1, 2023 to May 31, 2023. Area under the curve scores from a receiver operating characteristic curve were used to assess the validity of the Dynamic Appraisal of Situational Aggression in predicting the risk of future aggressive incidents.

Results

A total of 91,951 encounters were included for analysis, of which 90.57% initially presented to the emergency department. The area under the curve of the Dynamic Appraisal of Situational Aggression in predicting an aggressive incident was .63.

Discussion

The Dynamic Appraisal of Situational Aggression had moderate predictive validity for future incidents of violence when used for the general population in the emergency department and other acute care settings. Future research might assess whether reduced clinical variation may increase the validity of the Dynamic Appraisal of Situational Aggression for these settings. Presently, hospitals should consider alternative tools for reducing the incidence of violence in the emergency department.

引言：很少有暴力风险评估工具已被证实在普通人群中用于急诊科或随后的急性护理环境。本研究评估了情境攻击动态评估工具在这些环境下对普通人群的预测有效性。方法：于2022年7月对北卡罗莱纳州某大型医疗保健系统内所有急诊科和急症住院患者实施情境攻击动态评价。对2023年3月1日至2023年5月31日期间出院的所有18岁及以上患者进行回顾性分析。采用被试工作特征曲线的曲线下面积得分来评估情景攻击动态评价在预测未来攻击事件风险方面的有效性。结果：共纳入91,951例病例进行分析，其中90.57%最初就诊于急诊科。情境攻击动态评价预测攻击事件的曲线下面积为0.63。讨论：情境攻击的动态评估在用于急诊科和其他急症护理机构的普通人群时，对未来暴力事件具有中等的预测效度。未来的研究可能会评估临床差异的减少是否会增加情境攻击动态评估在这些环境中的有效性。目前，医院应考虑其他工具，以减少暴力事件的发生率在急诊科。

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引用次数: 0

Utility of Triage Nurses’ Quick-Look Assessments of Adults in the Emergency Department for Predicting Hospital Admission 急诊科分诊护士对成人的快速评估对预测住院的效用。

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jen.2025.06.002

Ryuji Suzuki MD, Toshihiko Takada MD, PhD, PMSc, MPH, Jun Miyashita MD, PhD, MPH, Shunichi Fukuhara MD, DMSc

Introduction

Nurses use quick-look assessments, vital signs, and interviews to predict hospital admission, but evidence for the predictive accuracy of quick-look assessments remains limited. This study aimed to evaluate the accuracy of quick-look assessments in predicting hospital admission for adult patients, compare their performance with the National Early Warning Score, and assess the added value of combining quick-look assessments and the National Early Warning Score.

Methods

This prospective, single-center, observational study was conducted in the emergency department of an acute care hospital. During triage, nurses predicted admission likelihood based only on quick-look assessments, without any other data such as vital signs or history of illness, with higher quick-look assessment scores indicating greater admission likelihood. The National Early Warning Score was calculated from vital sign data. Three predictive models (quick-look assessment alone, National Early Warning Score alone, and quick-look assessment + National Early Warning Score) were developed using logistic regression modeling. Model performance was assessed using the area under the curve and calibration plots.

Results

Of 1588 patients, 144 (9.1%) were admitted. Higher quick-look assessment scores were associated with admission, with odds ratios of 83.8 (95% CI, 26.6-263.8) and 145.2 (95% CI, 21.4-986.4) for quick-look assessment scores of 4 and 5, respectively. The quick-look assessment model had an area under the curve of 0.85 (95% CI, 0.81-0.88), outperforming the National Early Warning Score (area under the curve, 0.67; 95% CI, 0.62-0.73). Adding the National Early Warning Score to quick-look assessments led to minimal improvement (area under the curve, 0.87; 95% CI, 0.83-0.90). Calibration showed that quick-look assessments underestimated moderate-to-high-risk predictions.

Discussion

Quick-look assessments allow nurses to make accurate predictions of hospital admissions during ED triage, outperform the National Early Warning Score, and support better patient prioritization.

导读：护士使用快速评估、生命体征和访谈来预测住院情况，但快速评估预测准确性的证据仍然有限。本研究旨在评估快看评估在预测成年患者住院情况中的准确性，比较其与国家预警评分的表现，并评估快看评估与国家预警评分相结合的附加价值。方法：本前瞻性、单中心、观察性研究在一家急症护理医院的急诊科进行。在分诊过程中，护士仅根据快速评估预测入院可能性，而没有任何其他数据，如生命体征或病史，快速评估得分越高，入院可能性越大。国家早期预警评分是根据生命体征数据计算得出的。采用logistic回归模型建立了3个预测模型（单独快速评估、单独国家预警评分、快速评估+国家预警评分）。使用曲线下面积和校准图评估模型性能。结果：1588例患者中144例（9.1%）入院。较高的快速检查评分与入院相关，快速检查评分为4分和5分的比值比分别为83.8 （95% CI, 26.6-263.8）和145.2 （95% CI, 21.4-986.4）。快速评估模型的曲线下面积为0.85 (95% CI, 0.81-0.88)，优于国家预警评分(曲线下面积，0.67；95% ci, 0.62-0.73)。在快速评估中加入国家预警评分导致的改善最小(曲线下面积，0.87；95% ci, 0.83-0.90)。校准显示，快速评估低估了中等至高风险的预测。讨论：快速评估允许护士在急诊室分诊时准确预测住院情况，优于国家早期预警评分，并支持更好的患者优先排序。

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引用次数: 0

The Relationship Between Violence Tendency Levels and Intolerance of Uncertainty in Adults Presenting to the Emergency Department 急诊科成人暴力倾向水平与对不确定性的不耐受之间的关系

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jen.2025.04.018

Canan Demir Barutcu PhD, Hale Turhan Damar PhD

Introduction

This study aimed to investigate the relationship between the tendency toward violence and intolerance of uncertainty levels in patients presenting to emergency departments and associated factors.

Methods

The study was a descriptive, cross-sectional design. The research sample consisted of 315 patients who had presented to the emergency department. Data were collected using the patient descriptive characteristics form, the Intolerance of Uncertainty Scale-12, and the violence tendency scale.

Results

The average age of the patients was 35.52 (SD = 17.2) years. Of the sample, 56.8% were male, 57.5% were single, and 37.8% were high school graduates. Multiple regression analysis identified significant predictors of violence tendency, including being single (β = .135; P = .012), lower educational status (β = −.199; P < .001), lower satisfaction with emergency services (β = −.133; P = .015), higher prospective anxiety (β = .175; P = .004), and higher inhibitory anxiety (β = .130; P = .029).

Discussion

This study highlights the importance of understanding violence tendency in emergency departments from the patient’s perspective, revealing key factors such as intolerance of uncertainty, satisfaction with care, and sociodemographic characteristics. It is recommended that health managers take measures to increase patient satisfaction as well as raise social awareness and develop strategies to prevent violence against health care workers.

简介：本研究旨在探讨急诊科患者的暴力倾向与不确定程度的不耐受之间的关系及其相关因素。方法：采用描述性、横断面设计。研究样本包括315名到急诊科就诊的患者。数据采用患者描述性特征表、不确定性不耐受量表-12和暴力倾向量表收集。结果：患者平均年龄35.52岁（SD = 17.2）。样本中56.8%为男性，57.5%为单身，37.8%为高中毕业生。多元回归分析发现了暴力倾向的显著预测因素，包括单身(β = 0.135；P = 0.012)，教育程度较低(β = - 0.199；P < 0.001)，急救服务满意度较低(β = - 0.133；P = 0.015)，较高的预期焦虑(β = 0.175；P = 0.004)，抑制性焦虑较高(β = 0.130；P = .029)。讨论：本研究强调了从患者角度理解急诊科暴力倾向的重要性，揭示了诸如对不确定性的不容忍、对护理的满意度和社会人口特征等关键因素。建议卫生管理人员采取措施，提高患者满意度，提高社会认识，制定战略，防止对卫生保健工作者的暴力行为。

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引用次数: 0

Exploring Differences in Blood Product Administration by Patient Age and Injury Severity 探讨患者年龄和损伤严重程度对血液制品使用的差异。

IF 2.3 4区医学 Q2 EMERGENCY MEDICINE

Journal of Emergency Nursing

Pub Date : 2025-11-01 DOI: 10.1016/j.jen.2025.06.009

Madison Finch BSN, RN, Russell Griffin PhD, David E. Vance PhD, Allison R. Jones PhD

Introduction

Trauma-related hemorrhage is the leading cause of preventable death in the United States. Current resuscitation guidelines are based largely on data from younger and middle-aged adults, while influencing practice for adults of all ages. We examined age-related differences in blood product administration among individuals predicted to receive massive transfusions for the treatment of trauma-related hemorrhage.

Methods

A secondary analysis was performed using data from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial, including 640 critically injured adult patients from 12 level I trauma centers across North America. We included patients aged ≥18 years, with an injury severity score of ≥9, and who had data available for packed red blood cells transfused in the first 24 hours of hospitalization. Patients were categorized based on both injury severity score (moderate, 9-15; severe, 16-24; profound, 25+) and age (young, 18-39; middle aged, 40-59; older, 60+). Descriptive statistics were used to analyze injury severity, mechanism of injury, comorbid conditions, and preinjury medication use. A negative binomial regression was used to evaluate the relationship between the quantity of packed red blood cells administered and age and injury severity categories.

Results

Patients (N = 640) were primarily male (80.5%) and white (64.5%) who experienced either blunt (51.7%) or penetrating injuries (47%). Older adults with severe injury severity score were transfused 33% fewer units of packed red blood cells than young adults with severe injury severity score (count ratio, 0.67; 95% CI, 0.47-0.96; P = .031).

Discussion

Our findings support a potential difference in the quantity of blood products administered among patients based on age. Further investigation is required to better understand age-related treatment considerations for trauma-related hemorrhage.

在美国，创伤性出血是可预防死亡的主要原因。目前的复苏指南主要基于年轻人和中年人的数据，但对所有年龄段的成年人都有影响。我们检查了预期接受大量输血治疗创伤性出血的个体在血液制品管理方面的年龄相关差异。方法：采用实用、随机优化血小板和血浆比率试验的数据进行二次分析，包括来自北美12个一级创伤中心的640名重症成人患者。我们纳入了年龄≥18岁、损伤严重程度评分≥9、住院前24小时内可获得填充红细胞输注数据的患者。患者根据损伤严重程度评分(中度，9-15分；严重,16 - 24;深刻，25岁以上)和年龄(年轻，18-39岁；中年，40-59岁；老,60 +)。采用描述性统计分析损伤严重程度、损伤机制、合并症和损伤前用药情况。使用负二项回归来评估红细胞填充量与年龄和损伤严重程度类别之间的关系。结果：患者（N = 640）以男性（80.5%）和白人（64.5%）为主，经历过钝伤（51.7%）或穿透伤（47%）。有严重损伤严重程度评分的老年人比有严重损伤严重程度评分的年轻人输注的红细胞少33%(计数比，0.67；95% ci, 0.47-0.96；P = .031)。讨论：我们的研究结果支持基于年龄的患者血液制品用量的潜在差异。需要进一步的研究来更好地了解创伤性出血与年龄相关的治疗考虑。

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