江门市中心城区严重创伤结局预测模型

目的:探讨影响江门地区严重创伤结局的各种因素,建立适合本地区使用的严重创伤结局预测模型(AASCOT),为提高创伤救治水平及合理分配医疗资源提供依据.方法:回顾性分析本地区1092例严重创伤患者的资料,以严重创伤生存率为反应变量,对解剖损伤评分、SIRS评分、生理评分等进行Logistic回归分析,并计算各种因素的权重系数.结果:GCS、SIRS和收缩压(SBP)进入Logistic回归方程,解剖损伤评分及年龄因素并未进入回归方程.AASCOT模型的非线性回归方程为Ps=1/(1+e-b),e=2.718282;其中钝伤b=-5.964+1.548×GCS+1.199×Sbp+(-0.510)×SIRS;穿透伤b=-4.057+1.283×GCS+1.020×Sbp+(-0.946)×SIRS.结论:GCS、SIRS和SBP是影响本地区严重创伤结局的重要因素;AASCOT模型适合本地区国人的创伤结局预测,建议在本地区推广使用.     

生理创伤评分预测创伤结局

目的 探讨生理创伤评分，包括SIRS评分与其他常用的生理指标联合预测创伤结局的数学模型。方法 回顾分析1131例创伤数据，以生存概率为变量，Logistic回归分析伤员刚进急诊科时的GCS、收缩压、SIRS评分和年龄，并建立新的数学模型。结果 预测结局的准确性、敏感性与特异性接近ASCOT法，误判率降低。结 论该统计学模型具有简单实用、准确性高等特点，建议临床应用。     

急诊创伤患者死亡的相关因素与救治对策分析

目的探究影响急诊创伤患者死亡的相关因素,并分析其救治对策。方法回顾性分析2018年1月至2020年1月于我院接受急救但无效死亡的46例急诊创伤患者(死亡组)和同期抢救成功的178例急诊创伤患者(存活组)的临床资料。通过单因素及多因素Logistic回归方程分析两组患者的年龄、性别等相关因素,评估影响急诊创伤患者死亡的独立危险因素,并通过总结患者的死因,分析其临床救治对策。结果经单因素分析,两组年龄、ISS评分、GCS评分、就诊时间、损伤部位、机械通气情况有显著差异(P<0.05);而两组的性别、致伤原因、损伤数量、抢救措施比较,差异均无统计学意义(P>0.05)。经多因素Logistic回归分析结果显示,年龄、ISS评分、GCS评分、损伤部位、机械通气均属于急诊创伤患者死亡的独立危险因素(P<0.05)。46例死亡患者中,中枢性呼吸循环衰竭25例(54.35%),多器官功能衰竭12例(26.09%),失血性休克7例(15.22%),其他2例(4.35%)。结论年龄、ISS评分、GCS评分、损伤部位、机械通气均属于急诊创伤患者死亡的独立危险因素,临床应引起重视,提高抢救质量。     

颅脑损伤术后发生脑梗死的相关高危因素探讨

目的探讨颅脑损伤术后患者发生脑梗死的相关高危因素。方法选取2010年6月至2014年6月收治的颅脑损伤术后的800例患者为研究对象,对患者的年龄、性别、格拉斯哥昏迷评分(GCS)、脑血管痉挛、是否并发脑疝、脑挫裂伤、糖尿病、入院时血压等临床资料进行回顾性分析。采用描述性统计和Logistic回归分析颅脑损伤术后患者发生脑梗死的影响因素。结果 800例临床资料完整的颅脑损伤术后发生脑梗死的患者有45例,发生率为5.63%,死亡2例,病死率为4.44%,年龄、GCS评分、脑血管痉挛、并发脑疝、脑挫裂伤、糖尿病及低血压这7个因素经统计学检验差异有统计学意义(P0.05);经多因素Logistic回归分析发现颅脑损伤术后患者发生脑梗死与低龄、低GCS、低收缩压、脑血管痉挛、并发脑疝、脑损伤类型中的脑挫裂伤、糖尿病及低血压等因素关系密切。结论低龄、低GCS、低收缩压、脑血管痉挛、并发脑疝、脑损伤类型中的脑挫裂伤、糖尿病及低血压等因素可能是颅脑损伤患者术后发生脑梗死的危险因素,需要采取合理措施降低其对患者预后的影响,提高患者的生活质量。     

颅脑外伤患者预后相关因素分析

目的探讨影响颅脑外伤预后的相关风险因素。方法对性别、年龄、术前GCS评分、术前血糖水平、CRP、颅脑损伤类型及血肿量等12个相关指标进行单因素分析,对有意义的指标再行Logistic多因素回归分析。结果单因素分析显示:GCS、年龄、血糖值及脑肿胀等6个指标与预后有相关性(P0.05),Logistic多因素回归分析显示:GCS、年龄、血糖及脑肿胀可能为影响患者预后的独立因素(P0.05)。结论临床影响颅脑损伤患者预后因素很多,它们之间并非互相独立而是彼此影响的。但临床工作中更应注意术前GCS评分、年龄、术前血糖值及脑肿胀这四个因素。     

颅脑损伤患者术后心理弹性及影响因素分析

目的 分析颅脑损伤患者术后心理弹性及影响因素。方法 选择2019年1月～12月我院收治的颅脑损伤患者62例,所有患者均在术后进行心理弹性评估[心理弹性量表(CD-RISC)],设计一般资料调查表记录性别、年龄、经济条件、损伤部位、格拉斯昏迷指数(GCS)评分及颅内感染情况,分析颅脑损伤患者术后心理弹性的影响因素。结果经单因素分析,颅脑损伤患者术后心理弹性评分不受年龄、经济收入、损伤部位影响(P0.05);但可能受年龄、GCS评分、术后颅内感染的影响(P0.05)。Logistic回归分析结果显示,年龄≤45岁、GCS评分为中重度、术后伴有颅内感染是颅脑损伤患者术后心理弹性评分的影响因素(OR1,P0.05)。结论 年龄≤45岁、GCS评分为中重度、术后伴有颅内感染均可能是影响颅脑损伤患者术后心理弹性评分的危险因素,临床应据此制定相应干预措施。     

创伤患者血钾浓度的变化及其影响因素的Logistic回归分析

目的 明确创伤对患者血清钾离子浓度的影响并分析其影响因素.方法 回顾性分析收治我院急诊抢救室及急诊留观的创伤患者411例,分析创伤患者血钾浓度的分布规律,利用Logistic回归分析创伤患者的年龄、性别、受伤部位、GCS评分和ISS评分、受伤至入院后首次抽血的时间、血糖浓度、血钠浓度、pH值、D-二聚体浓度、骨折及饮酒对血钾浓度的影响.结果 单因素分析结果显示,影响创伤患者发生低钾的主要因素包括患者的受伤部位(单纯颅脑损伤及单纯非颅脑损伤)、入院时GCS评分和ISS评分、受伤至入院后首次抽血的时间及入院时血糖、血钠、D-二聚体浓度(P<0.05).多因素Logistic回归分析结果显示,受伤至入院后首次抽血的时间和入院时D-二聚体浓度是创伤患者发生低钾的独立影响因素(P<0.05).结论 临床上对早期入院的创伤患者及入院后查D-二聚体浓度较高的患者要及时关注其血钾情况,并进行及早处理,防止严重并发症的出现.     

颅脑损伤患者预后现状和影响因素分析

回顾性分析我院2014年1月~2014年11月收治的84例颅脑损伤患者资料,对患者现状及影响因素作多因素分析。结果 33例患者恢复良好,中残22例,重残18例,植物生存6例,死亡5例。经Logistic多因素回归分析显示,年龄、血糖、多发伤、GCS评分、休克是影响颅脑损伤患者预后结局的主要危险因素。颅脑损伤后患者预后不良,受许多因素影响,根据其影响因素,采取针对性措施进行干预,能有效对颅脑外伤患者的预后结局进行改善。     

影响急诊介入治疗骨盆骨折预后的多因素分析

目的:探讨与分析影响急诊介入治疗骨盆骨折预后的因素。方法:2014-02—2019-02期间在本院进行急诊介入的骨盆骨折患者160例,调查患者一般资料、骨折情况、临床诊治与预后情况。结果:在160例患者中,经过急诊介入后死亡16例(死亡组),存活144例(存活组),病死率为10.0%。死亡组的性别、年龄、收缩压、体重指数、舒张压、骨折分型、骨折原因、骨折部位与死亡组对比差异无统计学意义(P0.05),死亡组的伤后到院前时间、合并创伤状况、手术时间、输血情况等与死亡组对比差异有统计学意义(P0.05)。死亡组入院时的格拉斯哥预后评分(GCS)、简明损伤评分(AIS)、损伤严重程度评分(ISS)、急性生理与慢性健康状况评估Ⅱ(APACHEⅡ)评分与存活组对比差异均有统计学意义(P0.05)。死亡组急诊期间的呼吸衰竭、休克、感染等并发症发生率为50.0%,显著高于存活组的6.3%(P0.05)。Logistic回归分析显示GCS评分、AIS评分、ISS评分、APACHEⅡ评分、伤后到院前时间、合并创伤为患者预后死亡的主要影响因素(P0.05)。结论:骨盆骨折的预后相对比较差,多伴随有各种并发症,GCS评分、AIS评分、ISS评分、APACHEⅡ评分、伤后到院前时间、合并创伤为患者预后死亡的主要影响因素。     

急性颅脑损伤并全身炎症反应综合征的预后分析

目的研究急性颅脑损伤与全身炎症反应综合征(SIRS)发生的关系及对预后的影响。方法回顾性分析310急性颅脑损伤患者,根据SIRS诊断标准,研究SIRS发生与病情轻重、预后的关系,SIRS组再根据诊断标准项目符合数分组,分别比较各组病例的病死率。结果急性颅脑损伤后SIRS的发生率为61．0%,与性别、年龄无关,与GCS评分有一定关系,GCS评分越高, SIRS发生率越低;SIRS组的病死率显著高于非SIRS组(P＜0．05),且病死率随着SIRS严重程度增加而增高(P＜0．05)。结论急性颅脑损伤常合并SIRS,SIRS的发生与预后有关,应结合是否发生SIRS来综合判断急性颅脑损伤的轻重,SIRS的发生及严重程度可作为急性颅脑损伤预后判断及治疗指导的指标。     

高血压性脑室出血预后影响因素分析

目的 分析影响高血压性脑室出血预后的相关因素.方法 对162例高血压性脑室出血患者,6个月后用ADL分级判定预后,用统计学软件分析临床资料中各个参数与预后的关系.结果 高血压性脑室出血患者预后与患者性别、发病后血糖值、白细胞数无明显相关性,与年龄、脑实质血肿量、瞳孔对光反射、血压、GCS评分、发病后意识障碍存在一定相关性.结论 高血压性脑室出血患者与发病年龄、血压、脑实质血肿量、意识障碍及瞳孔对光反射相关,其中意识状态及血压与预后显著相关.为降低高血压脑室出血患者的致残率及死亡率,需控制其危险因素.     

rSIG与动脉血乳酸对重型颅脑创伤患者预后评估的价值

目的探讨rSIG(the reverse shock index multiplied by Glasgow coma scale score)与动脉血乳酸(Lac)对重型颅脑创伤患者预后评估的价值。方法回顾性分析某院急诊抢救室2016年8月至2019年9月收治的120例重型颅脑创伤患者的临床资料,以外伤后28 d预后情况为标准,将患者分为生存组(81例)和死亡组(39例)。比较两组患者的临床资料;分析影响重型颅脑创伤患者死亡的危险因素;分析rSIG与动脉血Lac及两者联合对重型颅脑创伤患者预后的预测价值。结果存活组的收缩压、舒张压、平均动脉压、GCS评分及rSIG均明显高于死亡组,动脉血Lac水平明显低于死亡组,差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示,收缩压、GCS评分、rSIG、动脉血Lac是重型颅脑创伤患者死亡的独立危险因素(P<0.05)。rSIG联合动脉血Lac对重型颅脑创伤患者死亡率的预测能力优于rSIG(P<0.05),但与动脉血Lac比较(P>0.05)。结论rSIG、动脉血Lac是重型颅脑创伤患者预后相关的独立危险因素,且对重型颅脑创伤患者伤情严重程度及预后有较好的预测价值。     

Intracranial injury following minor head trauma.

One hundred twelve patients presenting with a Glascow Coma Scale (GCS) score greater than or equal to 13 with a history of minor head trauma were prospectively studied to determine if certain historic or physical examination variables would predict which of these patients were at increased risk for intracranial injury. Patients either underwent cranial computed axial tomography (CT) or were followed up by phone at 4 weeks to determine major morbidity or mortality. Thirty-five patients underwent CT scanning of the head and eight demonstrated intracranial injury. Five patients were treated nonoperatively, and three patients had neurosurgical intervention. One patient died following surgery. At the 4-week follow-up no patient was found to have suffered any major morbidity or mortality. Stepwise logistic regression found age over 40 years (P = .05, odds ratio = 6.4, 95% confidence interval 1.0 to 38.8) and complaint of headache (P = .039, odds ratio 8.167, 95% confidence interval 1.074 to 62.09) to be significantly predictive of intracranial injury. All eight patients with positive CTs had a GCS score of 15. The authors conclude that intracranial injury does exist in patients suffering minor head trauma with a GCS score of 13 or above. Age over 40 years and complaint of headache are associated with an increased risk of intracranial injury.     

Incremental Benefit of Individual American College of Surgeons Trauma Triage Criteria

Objective: To determine the incremental benefit of individual American College of Surgeons (ACS) trauma triage criteria for prediction of severe injuries after consideration of concurrent physiologic, anatomic, mechanism, or “other” criteria. Methods: A prospective cross-sectional study of motor vehicle crash victims transported to any of the 12 hospitals in a suburbadrural county by local ambulance services was performed. Demographic and individual ACS criteria were collected using structured data instruments. EDs provided patient disposition within 24 hours of patient arrival. Medical records were reviewed. Major outcomes were admission, operative interventions (OR), major nonorthopedic operative interventions or death (Maj-OR), and injury severity score (ISS). To optimize sensitivity and specificity of out-of-hospital triage decision rules, receiver operating characteristic (ROC) curves were derived. Results: Of 1,545 patients, 13% were admitted; 6% had OR; 1% had Maj-OR; and 3% had ISSs ≥16. For all outcomes, the most useful criteria were physiologic and anatomic. Some additional criteria (crash speed >20 mph, ≥30-inch vehicle deformity, axle displacement) substantially worsened specificity. with minimal or no improvement in sensitivity. For example, the optimal ROC curve for Maj-OR was determined by a systolic blood pressure <90 mm Hg, Glasgow Coma Scale (GCS) score 43, respiratory rate (RR) <10 or >29, death of a same-car occupant, penetrating injury, and/or ≥24-inch opposite-side compartment intrusion (sensitivity, 85%; specificity, 87%). An ISS ≥16 was predicted by GCS score <13, RR <10 or >29, penetrating injury, 2 proximal long bone fractures, flail chest, ≥24-inch opposite-side compartment intrusion, patient ejection, rollover, and/or age <5 or >55 years (sensitivity, 86%; specificity, 70%). Conclusion: Physiologic and anatomic trauma triage criteria predicted increased hospital resource utilization and severe injury. On the other hand, when used concurrently with physiologic, anatomic, and “other” criteria, some mechanism criteria worsen specificity with negligible improvement in sensitivity. In particular, crash speed >20 mph and ≥30-inch vehicle deformity had little predictive value for all outcomes.     

ATLS P RACTICES AND S URVIVAL AT R URAL L EVEL III T RAUMA H OSPITALS , 1995-1999

Objective: To determine whether Advanced Trauma Life Support (ATLS) practices characterizing initial resuscitation and interfacility transfer at rural trauma hospitals are associated with risk-adjusted survival. Methods: Retrospective, observational analysis of rural injured patient survival. Process-of-care variables were associated with TRISS (trauma and injury severity score)-derived Z-statistics (95% confidence intervals) for high-risk population subsets (defined below). Inclusion criteria: all patients ≥12 years of age entered into a statewide trauma system, January 1, 1995, to December 31, 1999, and initially presenting to Level III trauma centers (N = 4,961). Exclusion criteria: pronounced dead on arrival (n = 26), directly admitted to hospital (n = 3), and unknown disposition at first hospital (n = 2). Process variables include: intubation in emergency department (ED) given Glasgow Coma Scale (GCS) score < 9 [ INTUB ], administration of blood products in ED given systolic blood pressure (SBP) < 90?mm Hg [ BLOOD ], trauma surgeon presence within 5 minutes of patient arrival given GCS < 9?mm Hg or SBP < 90?mm Hg [ UNSTABLE-TS ], trauma surgeon presence within 5 minutes of patient arrival given injury severity score (ISS) > 15 [ ISS-TS ], transfer to higher level of care given ISS > 20 and no hypotension [ TRAN ], transfer to higher level of care given GCS < 9 [ TRAN-GCS ]. Results: For the high-risk subpopulations, the following Z-scores (with and without an intervention) were found: Conclusions: Some ATLS interventions ( BLOOD , TRAN , and TRAN-GCS ) are associated with improved survival for selected high-risk subgroups in these 21 rural Level III trauma hospitals.     

Prehospital Factors Associated with Mortality in Injured Air Medical Patients

Abstract

Background. Air medical transport provides rapid transport to definitive care. Overtriage and the expense and risk of transport may offset survival benefits. Objective. We assessed the ability of prehospital factors to predict resource need for helicopter-transported patients. Methods. We performed a prospective, observational cohort analysis of injured scene patients taken to one of two level I trauma centers from October 2009 to September 2010. Variables analyzed included patient demographics, diagnoses, and clinical outcomes (in-hospital mortality, emergent surgery within 24 hours, blood transfusion within 24 hours, and intensive care unit [ICU] admission ≥24 hours, as well as a combined outcome of all clinical outcomes). Prehospital variables were prospectively obtained from air medical providers at the time of transport and included past medical history, mechanism of injury, and clinical factors. We compared those variables with and without the outcomes of interest via χ² analysis and the Kruskal-Wallis test, where appropriate. Multivariate logistic regression identified factors associated with outcomes of interest with the intent of developing a clinical prediction tool. Results. Five hundred fifty-seven patients were transported during the study period. The majority of the patients were male (67%) and white (95%) and had an injury that occurred in a rural location (58%). Most injuries were blunt (97%), and patients had a median Injury Severity Score (ISS) of 9. The overall mortality was 4%; 48% of the patients had one of the four outcomes. The most common reasons for requesting air transport were motor vehicle collision (MVC) with high-risk mechanism (18%), MVC at a speed greater than 20 mph (18%), Glasgow Coma Scale score (GCS) less than 14 (15%), and loss of consciousness (LOC) greater than 5 minutes (15%). Factors associated with mortality were age greater than 44 years, GCS less than 14, systolic blood pressure (SBP) less than 90 mmHg, and flail chest. This model had 100% sensitivity and 50% specificity and missed no deaths. The combined endpoint of all four outcomes (death, receipt of blood, surgery, ICU admission) included intubation by emergency medical services, two or more fractures of the humerus/femur, presence of a neurovascular injury, a crush injury to the head, failure to localize to pain on examination, GCS less than 14, or the presence of a penetrating head injury. This model had a sensitivity of 57% (53%–61%) and a specificity of 78% (75%–87%). Conclusions. Very few prehospital criteria were associated with clinically important outcomes in helicopter-transported patients. Evidence-based guidelines for the most appropriate utilization of air medical transport need to be further evaluated and developed for injured patients.