全面触发工具应用现状

Application Status of Global Trigger Tool

目的了解目前全面触发工具(GTT)国内外应用情况,为GTT在我国医疗机构的应用与完善提供参考。方法检索Pubmed、中国知网(CNKI)等数据库,查阅收集国内外GTT相关文献,并就GTT用于医疗不良事件(AE)检测相关应用进行分析与评价。结果共纳入有效研究58项,文献分布15个国家。研究涉及GTT应用的多个方面:AE发生率的测定(62.07%),明确AE发生对象类别的相关研究(36.21%),评估GTT作为AE测量工具的效能(27.59%),GTT应用效能的改进与探索(23.41%),GTT与其他AE检测方法的对比(15.52%);18.97%研究审评者数量及标准均按照GTT白皮书建议,32.76%研究对审评者没有明确描述;报告AE发生率的方法最常用表达方式是住院患者发生AE的比例;研究对象包括一般住院患者、儿童、重症监护患者(ICU)等共11类;一般住院患者发生AE的比例3.4%~43.3%,可预防比例32.2%~72.4%;最常见的AE事件类型是药物相关不良事件、感染/院内获得性感染、手术相关并发症、血钾异常、压力性溃疡等。目前美国、韩国、西班牙、中国等多个国家地区评估显示GTT具有高效性,GTT与其他AE检测方法(包括自愿报告系统、HMPS、QPSIQ、DLCR等)相比具有优势;对GTT性能改良的探索涉及不同资质审评者、审评者经验、抽样方法、样本大小、触发器等对检测效能的影响等多方面。结论 GTT已在多个国家地区应用于医疗机构患者的AE检测,并显示出一定优势,GTT不失为一种有效的AE检测工具,可在我国医疗机构AE监测中推广应用。

Objective To understand the current application status of global trigger tool （ GTT） in China and abroad, and to provide reference for application and improvement of GTT in medical institutes in China. Methods The databases of Pubmed and CNKI were searched, and the relevant literatures were reviewed and collected, and the application of GTT for measuring adverse events （ AE ） were analyzed and evaluated. Results Fifty-eight valid articles from 15 countries were included.The studies involve several aspects of GTT applications. Articles about GTT used for measuring the incidence of AE accounted for 62.07%, the researches on the object category of AE accounted for 36.21%, those evaluating the effectiveness of GTT as an AE measurement tool accounted for 27.59%, those about improvement and exploration of GTT application performance accounted for 23. 41%, and those about comparison between GTT and other AE detection methods accounted for 15. 52%. In 18.97% of the studies, the number of reviewers and criteria were accordant with the GTT White Paper, but 32.76% of the studies did not clearly describe the reviewers and criteria. The most common method for reporting the AE rate was the proportion of patients with AE.The research object includes 11 categories：common hospital patients, children, patients in intensive care unit （ ICU） , etc.; AE ratio of common hospital patients was 3. 4% to 43. 3%, the preventable proportion was between 32. 2% and 72.4%.The most common types of AE were drug related adverse events, infection/hospital acquired infections, surgery-related complications, abnormal blood potassium, pressure ulcer and so on. Evaluation performed in the United States, Republic ofKorea, Spain, China and other countries and regions＆#39; showed GTT had higher efficiency and other advantages as compared with the other AE detection methods including voluntary reporting system, HMPS, QPSIQ DLCR.The exploration of GTT performance improvement involves many factors influencing the detection effectiveness such as different reviewers, review experience, sampling method, sample size, trigger etc. Conclusion GTT has been applied to AE detection of hospital patients in various countries, and it has shown some advantages. GTT is an effective tool for AE measuring, which could be widely used in AE monitoring of hospitalized patients in medical institutions of China.