Ann Surge：预防致命性血凝块的新方法

来自约翰霍普金斯大学的研究者设计出了一种电脑化的名录系统，其可以帮助医生们发现并且使用最好的方法来预防创伤患者潜在的致命血块，从而降低危险的静脉血栓栓塞（VTEs）风险。相关研究成果刊登于国际杂志Archives of Surgery上。

研究者Elliott R. Haut表示，这种新型系统可以帮助病人有效预防接受低剂量血液缓蚀剂所带来的风险。任何人都可以患上VTE疾病，而且所有住院病人都会存在相应的并发症，如果给予合适的预防措施就会有效阻止致死性血块的发生。

每年在美国有超过600，000个人患上VTE，其中六分之一的人会死亡，在这项研究中，研究者将VTE的一些预防措施添加到了医院的电脑健康系统中，当信息进入系统之后，就会给予病人合适的预防静脉血栓栓塞的一些建议。

创伤病人通常患深静脉血栓形成和肺部栓塞风险较高，静脉血栓栓塞风险因子包括外科大手术和过度损伤，尤其是脊髓相关的损伤。研究者表示近些年来给予病人了很多相关的预防措施，但是问题是病人并不能够总是使用合适的方法来进行有效的预防行为。这种新型的电脑工具将会有效帮助病人，给病人提供合适的预防措施及建议。

Improved Prophylaxis and Decreased Rates of Preventable Harm With the Use of a Mandatory Computerized Clinical Decision Support Tool for Prophylaxis for Venous Thromboembolism in Trauma

Objective Venous thromboembolism is associated with substantial morbidity and mortality and is largely preventable. Despite this fact, appropriate prophylaxis is vastly underutilized. To improve compliance with best practice prophylaxis for VTE in hospitalized trauma patients, we implemented a mandatory computerized provider order entry–based clinical decision support tool. The system required completion of checklists of VTE risk factors and contraindications to pharmacologic prophylaxis. With this tool, we were able to determine a patient's risk stratification level and recommend appropriate prophylaxis. To evaluate the effect of our mandatory computerized provider order entry–based clinical decision support tool on compliance with prophylaxis guidelines for venous thromboembolism (VTE) and VTE outcomes among admitted adult trauma patients. Design Retrospective cohort study (from January 2007 through December 2010). Setting University-based, state-designated level 1 adult trauma center. Patients A total of 1599 hospitalized adult trauma patients with a hospital length of stay greater than 1 day. Main Outcome Measures The primary outcome measure was the proportion of patients who were ordered risk-appropriate guideline-suggested VTE prophylaxis. The secondary outcome measure was the proportion of patients with any preventable VTE (defined as VTE in a patient not ordered guideline-appropriate VTE prophylaxis), pulmonary embolism, and/or deep vein thrombosis. Results Compliance with guideline-appropriate prophylaxis increased from 66.2% to 84.4% (P < .001). The rate of preventable harm from VTE decreased from 1.0% to 0.17% (P = .04). Conclusions Implementation of a mandatory computerized provider order entry–based clinical decision support tool significantly improved compliance with VTE prophylaxis guidelines in hospitalized adult trauma patients. This improved compliance was associated with a significant decrease in the rate of preventable harm, which was defined as VTE events in patients not ordered appropriate prophylaxis.