培训水平是否预先决定院前败血症评估的成功率?早期识别的前瞻性调查

P. Kanizsai, G. Molnár, R. Sztudva, T. Berényi, I. Hornyák
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引用次数: 0

摘要

败血症是卫生专业人员面临的挑战。越来越多的病例强调了早期识别对提高生存率的重要性。针对脓毒症患者院前认知、治疗和护理途径进行问卷调查。在给出一个初始场景后,其他败血症样疾病作为诊断选择,并记录答案。在重新定义情况后,给出相同的潜在诊断,并检测正确答案的差异。应答者人数为120人。其中,33%的应答者选择低血容量、10%的过敏反应、2.5%的内分泌疾病、30.8%的全身炎症反应综合征/败血症、0.83%的内出血、0.83%的药物作用、2.5%的肺栓塞、19.17%的代谢紊乱作为主要诊断,其中训练有素的护理人员中强调正确答案的人数显著高于其他诊断。在重新定义情景后,63%的人改变了诊断,而37%的人没有改变(p < 0.001)。大多数应答者正确地选择了进一步的治疗。来自非护理人员的少量正确答案突出了需要更多的教育,以识别早期识别和治疗那些首先照顾病人的陷阱。训练有素的护理人员比其他代表更能识别败血症,因此有必要引入新的指导方针。
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Does level of training predetermine the success rate of prehospital sepsis assessment? A prospective survey on early recognition
Sepsis is a challenge for health professionals. The increasing number of cases emphasizes the importance of early recognition resulting in better survival. Questionnaires were spread focusing on the prehospital recognition, treatment, and care pathway of septic patients. After presenting an initial scenario, other sepsis-like diseases were given as diagnosis of choice and the answers were registered. After redefining the situation, the same potential diagnoses were given and the difference in correct answers was detected. The number of responders was 120. Among them, 33% of responders chose hypovolaemia, 10% allergic reaction, 2.5% endocrine disease, 30.8% systemic inflammatory response syndrome/sepsis, 0.83% internal bleeding, 0.83% drug effect, 2.5% pulmonary embolism, and 19.17% metabolic disorder as primary diagnosis with a significantly higher number of trained paramedics highlighting the correct answer. After redefining the scenario, 63% changed the diagnosis, while 37% did not change (p < .001). Further management was correctly chosen by the majority of responders. The small number of correct answers from non-paramedics highlights the need for more education in identifying the pitfalls of early recognition and therapy of those who attend patients first. Trained paramedics recognize the sepsis better than other representatives, necessitating the introduction of new guidelines.
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