Giảm đau nhanh cho chấn thương hông trước khi vào viện (RAPID): kết quả từ một nghiên cứu khả thi ngẫu nhiên

Pilot and Feasibility Studies - Tập 5 - Trang 1-13 - 2019
Jenna K. Jones1, Bridie A. Evans1, Greg Fegan1, Simon Ford2, Katy Guy2, Sian Jones3, Leigh Keen4, Ashrafunnesa Khanom1, Mirella Longo5, Ian Pallister1,2, Nigel Rees4, Ian T. Russell1, Anne C. Seagrove1, Alan Watkins1, Helen A. Snooks1
1Swansea University Medical School, Swansea, UK
2Swansea Bay University Health Board, Swansea, UK
3Patient and public representative, c/o Swansea University Medical School, Swansea, UK
4Welsh Ambulance Services NHS Trust, Saint Asaph, UK
5Cardiff School of Medicine, Cardiff, UK

Tóm tắt

Trong quản lý gãy hông, việc giảm đau hiệu quả trước khi nhập viện gặp nhiều khó khăn mà không có nguy cơ tác dụng phụ. Mặc dù các khoa cấp cứu thường xuyên sử dụng chặn khoang fascia iliaca (FICB), nhưng đã có rất ít đánh giá về việc sử dụng nó bởi các nhân viên cứu thương trước khi nhập viện. Chúng tôi nhằm mục đích đánh giá xem việc thực hiện một nghiên cứu ngẫu nhiên đa trung tâm để đánh giá FICB có khả thi hay không. Các nhân viên cứu thương tình nguyện đã sử dụng thẻ cào để phân bổ ngẫu nhiên bệnh nhân gãy hông giữa FICB và giảm đau theo cách thông thường. Các kết quả chính bao gồm tỷ lệ tử vong và chất lượng cuộc sống. Chúng tôi cũng đo lường các sự kiện bất lợi, chi phí, chẩn đoán cuối cùng, thời gian nằm viện, điểm đau và chất lượng dịch vụ, đồng thời thu thập dữ liệu định tính về mức độ chấp nhận của bệnh nhân qua phỏng vấn và của các nhân viên cứu thương trong các nhóm tập trung. Chúng tôi đã xác định trước các tiêu chí để quyết định xem có tiến tới thử nghiệm đầy đủ hay không dựa trên việc tuyển dụng nhân viên cứu thương và bệnh nhân, thực hiện FICB, thu thập dữ liệu kết quả, an toàn, mức độ chấp nhận và độ chính xác chẩn đoán của gãy hông. Chúng tôi đã đáp ứng hiệu quả tất cả các tiêu chí tiến triển: chúng tôi đã tuyển dụng 19 nhân viên cứu thương, những người đã phân bổ ngẫu nhiên 71 bệnh nhân giữa các nhánh thử nghiệm từ ngày 28 tháng 6 năm 2016 đến ngày 31 tháng 7 năm 2017; 57 (31 nhánh thử nghiệm, 26 nhánh chăm sóc thông thường, tổng cộng 80%) đã đồng ý tham gia theo dõi hồi cứu. Hơn một nửa (17/31) bệnh nhân tham gia thử nghiệm nhận FICB; tất cả các bệnh nhân khác đều có chống chỉ định, bao gồm chín bệnh nhân đang sử dụng thuốc chống đông. Bốn trong số 31 bệnh nhân được chỉ định FICB và sáu trong số 26 bệnh nhân được chỉ định chăm sóc thông thường đã tử vong trong vòng 6 tháng sau khi nhập viện. Các sự kiện bất lợi nghiêm trọng cũng tương tự: 3/35 thử nghiệm so với 4/36 trong chăm sóc thông thường. Nhận thức của nhân viên cứu thương về gãy hông có độ nhạy 49/64 (77%) với giá trị dự đoán dương tính 46/57 (81%). Chúng tôi đã nhận được bảng hỏi về chất lượng cuộc sống từ 30 trong số 49 bệnh nhân (61%) sau 1 tháng và 12 trong số 17 (71%) sau 6 tháng. Mức độ hài lòng của bệnh nhân tương tự nhau: trung bình nhóm thử nghiệm là 3.4 (n=20) so với 3.5 (n=13) cho nhóm chăm sóc thông thường. RAPID đã đạt được tất cả các tiêu chí tiến triển trong giới hạn hợp lý. Vì sự cân bằng vẫn còn, chúng tôi có kế hoạch thực hiện một thử nghiệm đa trung tâm đầy đủ để kiểm tra hiệu quả lâm sàng và chi phí của FICB do nhân viên cứu thương thực hiện tại hiện trường gãy hông.

Từ khóa

#gãy hông #FICB #quản lý đau #thử nghiệm ngẫu nhiên #nhân viên cứu thương

Tài liệu tham khảo

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