利用儿童美术作品提高开放性骨折患者及时服用抗生素的依从性。

IF 1.2 Q3 EMERGENCY MEDICINE Journal of Emergencies, Trauma, and Shock Pub Date : 2024-04-01 Epub Date: 2024-06-26 DOI:10.4103/jets.jets_133_23
Kathy Chu, Shahriar Zehtabchi, Valery Roudnitsky, Fred Harry, Bonny J Baron
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引用次数: 0

摘要

简介:开放性骨折(OFs)患者在到达急诊科(ED)60分钟内使用抗生素可降低患者的感染风险。我们测试了一种新颖的方法,即通过展示儿童图画来提示临床医生提高对开放性骨折早期抗生素治疗的依从性:方法:在一级创伤中心进行基于登记的干预前(2016 年 1 月 1 日至 2019 年 6 月 30 日)和干预后(2019 年 7 月 1 日至 2022 年 3 月 31 日)。2019 年 7 月,描绘 OF 的儿童艺术作品与 OF 指南一起在急诊室展出,并通过电子邮件发送给教师和住院医师。主要结果:在到达医院后 60 分钟内接受抗生素治疗的 OF 患者比例。使用抗生素的时间是从到达急诊室到电子病历中的用药时间戳计算的。我们将两组患者使用抗生素的时间作为连续变量进行比较。比例以百分比和 95% 置信区间 (CI) 表示;连续变量以中位数和四分位数表示。组间比较采用卡方检验(Chi-square)或曼-惠特尼U检验(Mann-Whitney U-tests):共确定了 554 名 OF 患者(排除:转院 = 1 人,急诊室死亡 = 4 人,使用抗生素时间不明确 = 11 人);实施前 281 人,实施后 257 人。中位年龄为 34 岁(四分位数为 24 岁和 46 岁)。受伤机制包括 300 例钝器伤(56%)和 238 例穿透伤(44%)。古斯蒂洛 OF 按类型分类如下:71% I级,13% II级,15% III级,1%未分类。60分钟内接受抗生素治疗的患者比例(58%,95% CI,52%-63% vs. 79%,95% CI,74%-84%)和接受抗生素治疗的时间(中位数:46分钟 vs. 25分钟)在前阶段和后阶段之间分别存在明显差异(P = 0.001):我们急诊室的儿童艺术作品提高了对 OF 指南的依从性,缩短了使用抗生素的时间。
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Using Children's Artwork to Improve Adherence with Timely Antibiotic Administration in Open Fractures.

Introduction: Antibiotics for open fractures (OFs) administered within 60 min of emergency department (ED) arrival reduce patients' infection risk. We tested a novel method of displaying children's drawings to prompt clinicians to improve adherence with early antibiotics for OFs.

Methods: Registry-based pre- (January 1, 2016-June 30, 2019) and post- (July 1, 2019-March 31, 2022) intervention at a level 1 trauma center. In July 2019, children's artwork depicting OF was displayed in the ED alongside OF guidelines and E-mailed to faculty and residents. Primary outcome: proportion of OF patients who received antibiotics within 60 min of arrival. Time to antibiotics was calculated from ED arrival to time-stamped administration in the electronic health record. We compared time to antibiotics as continuous variables between the two groups. Proportions are presented with percentages and 95% confidence interval (CI); continuous variables as median and quartiles. Chi-square or Mann-Whitney U-tests were used for group comparisons.

Results: Five hundred fifty-four total OF patients were identified (excluded: transferred = 1, ED death = 4, unclear time to antibiotics = 11); 281 pre-implementation and 257 post-implementation. The median age was 34 years (quartiles 24 and 46). Trauma mechanisms of injury included 300 blunt (56%) and 238 penetrating (44%). Gustilo OF classification by type were as follows: 71% I, 13% II, 15% III, 1% unclassified. There was a significant difference (P = 0.001) in both percentage of patients who received antibiotics within 60 min (58%, 95% CI, 52%-63% vs. 79%, 95% CI, 74%-84%) and time to antibiotics (median: 46 min vs. 25 min) between pre- and postphases, respectively.

Conclusions: Children's artwork in our ED improved adherence with OF guidelines and decreased time to antibiotics.

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来源期刊
CiteScore
2.90
自引率
7.10%
发文量
52
审稿时长
39 weeks
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