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Suzuki DRR, Santana LA, Ávila JEHG, Amorim FF, Modesto GP, Gottems LBD, Maldaner V. Quality indicators for hospital burn care: a scoping review. BMC Health Serv Res 2024; 24:486. [PMID: 38641612 PMCID: PMC11031897 DOI: 10.1186/s12913-024-10980-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/10/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Burn treatments are complex, and for this reason, a specialised multidisciplinary approach is recommended. Evaluating the quality of care provided to acute burn patients through quality indicators makes it possible to develop and implement measures aiming at better results. There is a lack of information on which indicators to evaluate care in burn patients. The purpose of this scoping review was to identify a list of quality indicators used to evaluate the quality of hospital care provided to acute burn patients and indicate possible aspects of care that do not have specific indicators in the literature. METHOD A comprehensive scoping review (PRISMA-ScR) was conducted in four databases (PubMed, Cochrane Library, Embase, and Lilacs/VHL) between July 25 and 30, 2022 and redone on October 6, 2022. Potentially relevant articles were evaluated for eligibility. General data and the identified quality indicators were collected for each included article. Each indicator was classified as a structure, process, or outcome indicator. RESULTS A total of 1548 studies were identified, 82 were included, and their reference lists were searched, adding 19 more publications. Thus, data were collected from 101 studies. This review identified eight structure quality indicators, 72 process indicators, and 19 outcome indicators listed and subdivided according to their objectives. CONCLUSION This study obtained a list of quality indicators already used to monitor and evaluate the hospital care of acute burn patients. These indicators may be useful for further research or implementation in quality improvement programs. TRIAL REGISTRATION Protocol was registered on the Open Science Framework platform on June 27, 2022 ( https://doi.org/10.17605/OSF.IO/NAW85 ).
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Affiliation(s)
- Denise R Rabelo Suzuki
- Programa de Pós-Graduação em Ciências para a Saúde, Escola Superior de Ciências da Saúde (ESCS/FEPECS), SMNH Quadra 3 Conjunto A Bloco 01 Edifício Fepecs, Asa Norte, Brasília, Distrito Federal, Brazil.
- Secretaria de Saúde do Distrito Federal (SES-DF), Setor de Rádio e TV Norte (SRTVN) 701, Via W5 Norte, lote D, Brasília, Distrito Federal, Brazil.
- Unidade de Queimados, Hospital Regional da Asa Norte (HRAN), 3° andar. Setor Médico Hospitalar Norte Q 2, Brasília, Distrito Federal, 70710-100, Brazil.
| | - Levy Aniceto Santana
- Programa de Pós-Graduação em Ciências para a Saúde, Escola Superior de Ciências da Saúde (ESCS/FEPECS), SMNH Quadra 3 Conjunto A Bloco 01 Edifício Fepecs, Asa Norte, Brasília, Distrito Federal, Brazil
- Secretaria de Saúde do Distrito Federal (SES-DF), Setor de Rádio e TV Norte (SRTVN) 701, Via W5 Norte, lote D, Brasília, Distrito Federal, Brazil
| | - Juliana Elvira H Guerra Ávila
- Secretaria de Saúde do Distrito Federal (SES-DF), Setor de Rádio e TV Norte (SRTVN) 701, Via W5 Norte, lote D, Brasília, Distrito Federal, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, Distrito Federal, Brazil
- Unidade de Queimados, Hospital Regional da Asa Norte (HRAN), 3° andar. Setor Médico Hospitalar Norte Q 2, Brasília, Distrito Federal, 70710-100, Brazil
| | - Fábio Ferreira Amorim
- Programa de Pós-Graduação em Ciências da Saúde, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, Distrito Federal, Brazil
| | - Guilherme Pacheco Modesto
- Programa de Pós Graduação em Ciências do Movimento Humano e Reabilitação, Universidade Evangélica de Goiás, Cidade Universitária, Avenida Universitária, Anápolis, Goiás, Brazil
| | - Leila Bernarda Donato Gottems
- Programa de Pós-Graduação em Ciências para a Saúde, Escola Superior de Ciências da Saúde (ESCS/FEPECS), SMNH Quadra 3 Conjunto A Bloco 01 Edifício Fepecs, Asa Norte, Brasília, Distrito Federal, Brazil
- Secretaria de Saúde do Distrito Federal (SES-DF), Setor de Rádio e TV Norte (SRTVN) 701, Via W5 Norte, lote D, Brasília, Distrito Federal, Brazil
| | - Vinicius Maldaner
- Programa de Pós Graduação em Ciências do Movimento Humano e Reabilitação, Universidade Evangélica de Goiás, Cidade Universitária, Avenida Universitária, Anápolis, Goiás, Brazil
- Universidade de Brasília (UnB), Ceilândia Sul Campus Universitário, Centro Metropolitano, Ceilândia, Distrito Federal, Brazil
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Crochemore T, Görlinger K, Lance MD. Early Goal-Directed Hemostatic Therapy for Severe Acute Bleeding Management in the Intensive Care Unit: A Narrative Review. Anesth Analg 2024; 138:499-513. [PMID: 37977195 PMCID: PMC10852045 DOI: 10.1213/ane.0000000000006756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 11/19/2023]
Abstract
This is a narrative review of the published evidence for bleeding management in critically ill patients in different clinical settings in the intensive care unit (ICU). We aimed to describe "The Ten Steps" approach to early goal-directed hemostatic therapy (EGDHT) using point-of-care testing (POCT), coagulation factor concentrates, and hemostatic drugs, according to the individual needs of each patient. We searched National Library of Medicine, MEDLINE for publications relevant to management of critical ill bleeding patients in different settings in the ICU. Bibliographies of included articles were also searched to identify additional relevant studies. English-language systematic reviews, meta-analyses, randomized trials, observational studies, and case reports were reviewed. Data related to study methodology, patient population, bleeding management strategy, and clinical outcomes were qualitatively evaluated. According to systematic reviews and meta-analyses, EGDHT guided by viscoelastic testing (VET) has been associated with a reduction in transfusion utilization, improved morbidity and outcome in patients with active bleeding. Furthermore, literature data showed an increased risk of severe adverse events and poor clinical outcomes with inappropriate prophylactic uses of blood components to correct altered conventional coagulation tests (CCTs). Finally, prospective, randomized, controlled trials point to the role of goal-directed fibrinogen substitution to reduce bleeding and the amount of red blood cell (RBC) transfusion with the potential to decrease mortality. In conclusion, severe acute bleeding management in the ICU is still a major challenge for intensive care physicians. The organized and sequential approach to the bleeding patient, guided by POCT allows for rapid and effective bleeding control, through the rational use of blood components and hemostatic drugs, since VET can identify specific coagulation disorders in real time, guiding hemostatic therapy with coagulation factor concentrates and hemostatic drugs with individual goals.
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Affiliation(s)
- Tomaz Crochemore
- From the Department of Critical Care, Hospital Vila Nova Star, São Paulo, Brazil
- Department of Critical Care, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Werfen LATAM, São Paulo, Brazil
| | - Klaus Görlinger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Germany
- TEM Innovations GmbH/Werfen PBM, Munich, Germany
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Bucher F, Dastagir N, Obed D, Enechukwu A, Dieck T, Vogt PM, Dastagir K. Factor XIII: More than just a fibrin stabilizer for the burn patient? A matched-pair analysis. JPRAS Open 2023; 37:1-8. [PMID: 37288428 PMCID: PMC10242619 DOI: 10.1016/j.jpra.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/15/2023] [Indexed: 06/09/2023] Open
Abstract
Background Acquired factor XIII deficiency is an underestimated risk in patients with large surface burns, which potentially exposes these patients to prolonged bleeding and delayed wound healing if undetected. Methods A retrospective matched-pair analysis of the burn registry of the Department of Plastic, Aesthetic, Hand, and Reconstructive Surgery of Hannover Medical School was performed from 2018 to 2023. Results A total of 18 patients were included. Acquired factor XIII deficiency was not statistically significant correlated with age, sex, or body mass index. Patients who developed acquired factor XIII deficiency had a significantly longer hospital stay (72.8 days) compared with those in the matched group (46.4 days), although burn depths, total body surface area, and Abbreviated Burn Severity Index were not statistically correlated with factor XIII deficiency. Conclusions Little is known about acquired factor XIII deficiency in patients with burns. Factor XIII supplementation may improve hemostasis, wound healing, and general outcome while reducing the patient's exposure to blood products.
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Affiliation(s)
- Florian Bucher
- Corresponding author: Florian Bucher MD, Department of Plastic, Aesthetic, Hand, and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany, Fax: +49 511 532-8864 Tel.: +49 176 15323754
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The impact of acquired coagulation factor XIII deficiency in traumatic bleeding and wound healing. Crit Care 2022; 26:69. [PMID: 35331308 PMCID: PMC8943792 DOI: 10.1186/s13054-022-03940-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Abstract
Factor XIII (FXIII) is a protein involved in blood clot stabilisation which also plays an important role in processes including trauma, wound healing, tissue repair, pregnancy, and even bone metabolism. Following surgery, low FXIII levels have been observed in patients with peri-operative blood loss and FXIII administration in those patients was associated with reduced blood transfusions. Furthermore, in patients with low FXIII levels, FXIII supplementation reduced the incidence of post-operative complications including disturbed wound healing. Increasing awareness of potentially low FXIII levels in specific patient populations could help identify patients with acquired FXIII deficiency; although opinions and protocols vary, a cut-off for FXIII activity of ~ 60–70% may be appropriate to diagnose acquired FXIII deficiency and guide supplementation. This narrative review discusses altered FXIII levels in trauma, surgery and wound healing, diagnostic approaches to detect FXIII deficiency and clinical guidance for the treatment of acquired FXIII deficiency.
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Grottke O, Callum J, Cushing MM, Haas T. The use of coagulation factor concentrates for perioperative bleeding management - a global perspective. Transfusion 2020; 60:663-666. [PMID: 32154943 DOI: 10.1111/trf.15749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Oliver Grottke
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Jeannie Callum
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada.,Laboratory Medicine Program, University Health Network, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine and Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Thorsten Haas
- Department of Pediatric Anesthesia, Zurich University Children's Hospital, Zurich, Switzerland
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