创伤严重度改良评分法在颅脑损伤中的应用评价

目的:探讨创伤严重度改良评分法对颅脑损伤患者伤情严重度的评估价值并与ISS进行比较。方法:对我院收治的221例颅脑损伤患者用RISS和ISS法进行比较分析。结果:死亡组RISS、ISS分值均明显高于存活组(P<0.01),RISS与ISS平均分值与病死率呈正相关,RISS计分平均26.13以上表示伤情严重,死亡率明显增加,各计分段RISS计分值均较ISS计分值高,且变化幅度大。结论:RISS与ISS计分法对颅脑损伤的伤情评估具有同步性,但RISS评分值较高,各计分段变化幅度大,更直观地反映了颅脑损伤的严重程度。     

改良澳大利亚预检系统在急诊创伤患者分诊中的应用研究

目的探讨改良澳大利亚预检系统(Australian Triage Scale,ATS)在急诊创伤患者分诊中的应用价值。方法组织专业人员对澳大利亚预检系统进行翻译,并结合我国临床工作实际情况进行修订和改进。将178例批量创伤患者按照时间顺序分为对照组(87例)和观察组(91例)。对照组应用AIS-ISS评分检伤分诊,观察组应用ATS系统评估分诊。比较两组在检伤分诊时间、分诊准确率、抢救成功率和患者/家属对分诊工作满意度。结果观察组评估分诊时间短于对照组(P0.01);而分诊准确率、抢救成功率、患者/家属对分诊工作满意度显著高于对照组(均P0.05)。结论改良澳大利亚预检系统能快速评估伤情,指导急诊抢救治疗工作,减少分诊盲目性、增强准确性,为急诊创伤患者及时救治、合理分流提供科学依据。     

改良SIRS评分在严重创伤患者中的应用

目的探讨改良的SIRS评分（R—SIRS）对严重创伤患者的应用价值。方法275例严重创伤患者于入院时进行R—SIRS评分,同时统计患者的住ICU时间、住院时间及28天死亡率,对结果进行分析。结果R—SIRS评分越高,患者住ICU时间及住院时间越长,28天死亡率越高。结论R—SIRS评分对严重创伤患者预后有一定预测价值。     

创伤评分在基层医院创伤患者救治中的应用

创伤评分（Trauma Score,TS）是判断患者伤情严重程度的标准,其对多发伤患者诊断、治疗及判断预后,具非常重要的意义。近年来,笔者对在运用创伤评分接诊创伤患者时发现其具有非常积极的作用,现总结报告如下。     

创伤严重度改良评分法对2260例创伤患者的前瞻性研究

目的探讨创伤严重度改良评分法（RISS）的临床实用价值，根据RISS值界定损伤严重程度。方法运用RISS法对1997年1月～2002年12月收治的2260例创伤患者进行前瞻性评估分析。结果RISS值随损伤部位数量增加而增高，并与损伤程度、伤残及死亡率呈正相关（P〈0．01）。生存者RISS值平均为（12．82±8．51）分，死亡者RISS值平均为（34．47±14．88）分（P〈0．01）。单处伤RISS值最低[（11．12±8．20）分]，多处伤次之[（13．81±4．67）分]，多发伤RISS值最高[（18．23±11、75）分]（P〈0．01）。结论RISS法能客观准确地反映各类损伤的创伤严重度，RISS〈9分为轻伤，RISS 9—15分为中度伤，RISS 16—25分为重伤，RISS 26～35分为严重伤，RISS〉35分为危重伤。     

153例急诊多发创伤早期救治体会

本院自2001年8月至2005年8月设立急诊中心，开展以专业化急诊医师进行救冶的创伤模式，共抢救多发伤153例。现就早期诊断及抢救等体会分析如下。     

急诊创伤患者低体温风险评分量表的研制

目的 研制急诊创伤患者低体温风险评分量袁,验证其临床预测效果.方法 选取489例急诊创伤患者作为建模组,根据是否出现低体温分为为低体温组和常温组,采用二元Logistic回归法分析影响创伤低体温的独立风险因素,构建创伤低体温风险评分量表,确定预测界值.再选取228例急诊创伤患者作为验证组,使用构建的量表预测评分,根据实际低体温的发生情况验证预测效果.结果 建模组构建的创伤低体温风险评分量表包括4个条目:受伤环境温度≤8℃(1分),修正创伤评分＜4分(2分),衣物潮湿(2分),入室时发生休克(2分).验证组中低体温组患者和体温正常组患者风险评分量袁评分差异具有统计学差异(P＜0.01).预测界值3分时,量表预测敏感度为0.709、特异度为0.920、阳性预测值为82.24％、阴性预测值为85.63％、总体正确率为86.08％,ROC曲线下面积为0.829[95％CI(0.769,0.888)].结论 构建的急诊创伤患者低体温风险评分量表具有良好的区分度和预测效果,可用于创伤患者低体温预测.     

应用CRAMS评分法规范基层医院急诊创伤患者院内转运

目的探讨CRAMS评分法用于院内转运急诊创伤患者的效果,提高院内转运安全性。方法对2011年收治的1 532例急诊创伤患者采用传统方式转运,即接诊护士凭借个人经验判断患者病情,决定是否需要护送、由谁承担护送任务;对2012年收治的1 609例急诊创伤患者于转运前、到达病区后应用CRAMS评分法进行动态评价,根据转运前CRAMS得分确定护送转运人员资质,完善转运前准备。结果应用CRAMS评分法转运急诊创伤患者后,护送人员资质与患者满意度显著高于传统方法(均P<0.01),患者转运过程中心脏骤停由3例降至零。结论CRAMS评分法在急诊创伤患者转运中的动态评价有利于提高护士的伤情识别能力与转运风险评估能力,能规范护送人员资质,促进转运前充分准备与告知,提高创伤患者转运安全性。     

改良早期预警评分在急诊120患者分诊中的应用

目的 探讨改良早期预警评分系统(MEWS)在急诊120患者分诊中的应用效果.方法 选取2010年11月120就诊患者311例为对照组,2011年11月120就诊患者306例为观察组.对照组患者入院后按常规急诊分诊流程处置;观察组患者采用MEWS评分系统,根据评分情况分流至相应就诊区域.比较两组分诊准确率并观察不同MEWS评分患者去向与转归情况.结果 观察组分诊准确率显著高于对照组(P＜0.05);MEWS评分5～8分患者容易出现病情变化,是潜在的危重患者.结论 MEWS评分便于急诊护士更准确地将患者分诊至相应就诊区域,有利于鉴别潜在危重患者,提高救治成功率.     

Statistical validation of the Revised Trauma Score

BACKGROUND: To validate the accuracy of the Revised Trauma Score (RTS) and its components for predicting in-hospital mortality. METHODS: Analyses were based on 22,388 patients from the trauma registries of three urban Level I trauma centers in the province of Quebec, Canada. The accuracy of RTS coded variables for the Glasgow Coma Score (GCSc), Systolic Blood Pressure (SBPc), and Respiratory Rate (RRc) for predicting mortality was evaluated in logistic regression models with measures of discrimination and model fit and compared with Fractional Polynomial (FP) transformations of each component. RESULTS: RTS coded variables were associated with sparse data distributions and did not accurately represent the relation of GCS, SBP, and RR to mortality. FP models were always associated with significantly better discrimination (all p < 0.00001) and model fit. Survival probability estimates generated by the model with FP transformations were significantly different to those generated by the model with RTS-coded variables. CONCLUSIONS: The RTS in its present form does not accurately describe the relation of GCS, SBP, and RR to mortality. FP transformation would improve the accuracy of predicted survival probabilities used for performance evaluation and may improve control of confounding caused by of physiologic severity case mix in trauma research.     

A Comparison of the Kampala Trauma Score (KTS) with the Revised Trauma Score (RTS), Injury Severity Score (ISS) and the TRISS Method in a Ugandan Trauma Registry

Abstract Background: The public health significance of injuries that occur in developing countries is now recognized. In 1996, as part of the injury surveillance registry in Kampala, Uganda, a new score, the Kampala Trauma Score (KTS) was instituted. The KTS, developed in light of the limited resource base of sub-Saharan Africa, is a simplified composite of the Revised Trauma Score (RTS) and the Injury Severity Score (ISS) and closely resembles the Trauma Score and Injury Severity Score (TRISS). Patients and Methods: The KTS was applied retrospectively to a cohort of prospectively accrued urban trauma patients with the RTS, ISS and TRISS calculated. Using ROC (receiver operating characteristics) analysis, logistic regression models and sensitivity and specificity cutoff analysis, the KTS was compared to these three scores. Results: Using logistic regression models and areas under the ROC curve, the RTS proved a more robust predictor of death at 2 weeks in comparison to the KTS. However, differences in screening performance were marginal (areas under the ROC curves were 87% for the RTS and 84% for the KTS) with statistical significance only reached for an improved specificity (67% vs. 47%; p < 0.001), at a fixed sensitivity of 90%. In addition, the KTS predicted hospitalization at 2 weeks more accurately. Conclusion: The KTS statistically performs comparably to the RTS and ISS alone as well as to the TRISS but has the added advantage of utility. Therefore, the KTS has potential as a triage tool in resource-poor and similar health care settings.     

骨盆创伤知名血管损伤的紧急处理策略

目的 探讨骨盆创伤中骨盆知名血管损伤时的紧急处理策略。方法 回顾性分析2005年1月至2021年10月山东省立医院收治的58例骨盆知名血管损伤病人的临床资料,其中男36例,女22例,年龄为（47.9±14.8）岁（24~75岁）。其中“死亡冠”血管损伤15例（医源性损伤8例）;臀上动静脉损伤17例（医源性损伤7例）;臀下动静脉损伤6例（医源性损伤1例）;阴部内动脉损伤13例;髂外动静脉（股动静脉）损伤7例（医源性损伤3例）。所有病人根据不同的血管损伤机制,术中根据不同的情况分别选择直接血管结扎、纱布填塞、血管造影栓塞或联合腹主动脉阻断等方法急救止血。结果 58例骨盆知名血管损伤的病人,其中有55例病人得到成功的处理,术后存活。其中2例因“死亡冠”血管损伤所致的大出血死亡,1例因臀上动脉医源性损伤所致的大出血死亡。结论 临床医生在面对骨盆及臀部创伤时要充分了解并掌握骨盆知名血管损伤的预防和处理,同时也不能忽视骨盆知名血管的潜在损伤。了解骨盆骨折类型与血管损伤的潜在联系,对于“死亡冠”血管,可行预防性结扎避免损伤,一旦损伤在无法结扎的情况下应纱布填塞压迫止血结合介入栓塞;对于臀上和臀下血管,造影栓塞可作为第一选择,必要时可联合腹主动脉球囊阻断;对于阴部内动脉,纱布填塞及造影栓塞均有较好的效果;对于髂外血管的损伤,可在腹主动脉球囊阻断下行血管修补或置换。当骨盆知名血管损伤时,根据具体情况,掌握止血急救的措施,根据自已医院条件和自身的经验选择合适的方法,提高病人的预后和生存率。     

Modification of the Trauma and Injury Severity Score (TRISS) Method Provides Better Survival Prediction in Asian Blunt Trauma Victims

Background  

The objective of the present study was to identify logistic regression models with better survival prediction than the Trauma and Injury Severity Score (TRISS) method in assessing blunt trauma (BT) victims in Japan and Thailand. An additional aim was to demonstrate the feasibility of probability of survival (Ps) estimation without respiratory rate (RR) on admission, which is often missing or unreliable in Asian countries.     

The Trauma and Injury Severity Score (TRISS) revised

Background

The Trauma and Injury Severity Score (TRISS) remains the most commonly used tool for benchmarking trauma fatality outcome. Recently, it was demonstrated that the predictive power of TRISS could be substantially improved by re-classifying the component variables and treating the variable categories nominally. This study aims to develop revised TRISS models using re-classified variables, to assess these models’ predictive performances against existing TRISS models, and to identify and recommend a preferred TRISS model.

Materials and methods

Revised TRISS models for blunt and penetrating injury mechanism were developed on an adult (aged ≥15 years) sample from the National Trauma Data Bank National Sample Project (NSP), using 5-category variable classifications and weighted logistic regression. Their predictive performances were then assessed against existing TRISS models on the unweighted NSP, National Trauma Data Bank (NTDB), and New Zealand Database (NZDB) samples using area under the Receiver Operating Characteristic curve (AUC) and Bayesian Information Criterion (BIC) statistics.

Results

The weighted NSP sample included 1,124,001 adults with blunt or penetrating injury mechanism events and known discharge status, of whom 1,061,709 (94.5%) survived to discharge. Complete information for all TRISS variables was available for 896,212 (79.7%). Revised TRISS models that included main-effects and two-factor interaction terms had superior AUC and BIC statistics to main-effects models and existing TRISS models for patients with complete data in NSP, NTDB and NZDB samples. Predictive performance decreased as the number of variables with missing values included within revised TRISS models increased, but model performances generally remained superior to existing TRISS models.

Discussion

Revised TRISS models had importantly improved predictive capacities over existing TRISS models. Additionally, they were easily computed, utilised only those variables already collected for existing TRISS models, and could be applied and produce meaningful survival probabilities when one or more of the predictor variables contained missing values. The preferred revised TRISS model included main-effects and two-factor interaction terms and allowed for missing values in all predictor variables. A strong case exists for replacing existing TRISS models in trauma scoring systems benchmarking software with this preferred revised TRISS model.     

皮内缝合术在急诊面部创伤治疗中的应用效果

目的 探讨皮内缝合术在急诊面部创伤治疗中的应用效果。方法 选取2021年8月-2023年12月于本 院急诊就诊的80例面部创伤患者为研究对象,以随机数字表法分为常规组与研究组,每组40例。两组均予 以基础术前准备,常规组采用间断缝合术治疗,研究组采用皮内缝合术治疗,比较两组疼痛程度、创面愈 合效果、瘢痕情况以及并发症发生情况。结果 研究组术后1、3 d VAS评分低于常规组,差异有统计学意 义（P＜0.05）;研究组创口愈合总有效率高于常规组,差异有统计学意义（P＜0.05）;研究组瘢痕色泽、 血管分布、厚度、柔软度评分均低于常规组,差异有统计学意义（P＜0.05）;研究组并发症发生率低于常 规组,差异有统计学意义（P ＜0.05）。结论 急诊面部创伤治疗中应用皮内缝合术能够有效提升创面愈合 效果,减轻患者疼痛程度,减少瘢痕形成,并降低并发症的发生几率,值得临床应用。     

Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score

Evaluation of trauma care must be an integral part of any system designed for care of seriously injured patients. However, outcome review should offer comparability to national standards or norms. The TRISS method offers a standard approach for evaluating outcome of trauma care. Anatomic, physiologic, and age characteristics are used to quantify probability of survival as related to severity of injury. TRISS offers a means of case identification for quality assurance review on a local basis, as well as a means of comparison of outcome for different populations of trauma patients. Methods for calculating statistics associated with TRISS are presented. The Z and M statistics are explained with the nonstatistician in mind. We feel this article is a source for those interested in developing or upgrading trauma care evaluation.     

整形美容修复技术在急诊面部创伤治疗中的运用

目的 分析整形美容修复技术在急诊面部创伤治疗中的应用效果。方法 选取我院2022年3月-2023年 12月收治的88例急诊面部创伤患者为研究对象,按照随机数字表法分成对照组与观察组,每组44例。对照组 采用常规外科修复技术,观察组采用整形美容修复技术,比较两组创面愈合情况、生活质量、并发症发生情 况及术后满意度。结果 观察组创面愈合优良率高于对照组,差异有统计学意义（P ＜0.05）;观察组治疗 后生理机能、一般健康状况、社会功能、情感职能评分高于对照组,差异有统计学意义（P ＜0.05）;观察组 并发症发生率为9.09%,低于对照组的22.73%,差异有统计学意义（P＜0.05）;观察组术后满意度高于对照 组,差异有统计学意义（P ＜0.05）。结论 对急诊面部创伤患者实施整形美容修复技术能够促进其创面 愈合,减少并发症发生几率,提高术后满意度,改善其负面情绪及生活质量,值得临床应用。     

整形美容修复技术在急诊面部创伤治疗中的应用效果

目的 探讨整形美容修复技术在急诊面部创伤治疗中的应用效果。方法 选取2017年1月-2022年5月我院急诊收治的80例面部创伤患者为研究对象,采用随机数字表法分为对照组与观察组,每组40例。对照组予以常规外科修复,观察组予以整形美容修复技术,比较两组创伤修复效果、生活质量、满意度及并发症发生情况。结果 观察组修复优良率为92.50%,高于对照组的72.50%,差异有统计学意义（P＜0.05）;观察组精神健康、生理功能、活力和社会功能评分均高于对照组,差异有统计学意义（P＜0.05）;观察组满意度高于对照组,差异有统计学意义（P＜0.05）;观察组并发症总发生率为5.00%,低于对照组的22.50%,差异有统计学意义（P＜0.05）。结论 在急诊面部创伤患者治疗工作中采用整形美容修复技术所获得的修复效果较常规外科修复更优,术后并发症少,可进一步提高患者的生活质量和满意度,值得临床应用。面部创伤;整形美容修复技术;常规外科修复