CRAMS和NISS组合创伤评分在抢救护理中的应用金霞 胡三莲 张妮娜

目的 研究CRAMS和NISS创伤评分在急诊抢救护理中的应用。 方法 对1328例急诊创伤患者 采用急诊CRAMS评分和NISS创伤评分评价及RTC初级创伤评分对患者的创伤情况进行评价。 结果 CRAMS联合 NISS创伤评分对重症创伤患者伤情判断正确率为 46．15% ,创伤患者急诊抢救时间 144.89?88.12 分,抢救成功率 97.74 %,较传统RTS评分要高,且差异具有统计学意义(P﹤0.05)。 结论 CRAMS联合NISS创伤评分不仅可作为急诊创伤患者的分拣及护理分级的首选评分,同时也对创伤护理和评估患者预后具有重要意义。     

早期预警评分联合创伤严重程度评分在多发性创伤急救患者中的应用

目的探讨早期预警评分联合创伤严重程度(CRAMS)评分在多发性创伤急救护理中的应用价值。方法选取2017年12月至2018年12月收治的50例急诊多发性创伤患者为研究对象,随机将其等分为研究组和对照组,对照组实施CRAMS评估急救护理,研究组实施基于早期预警评分联合CRAMS评分的急救护理,比较两组患者接受不同评估系统下的急诊抢救时间、抢救成功率。结果研究组急诊抢救时间明显短于对照组,研究组的抢救成功率明显高于对照组,差异均有统计学意义(P 0. 05)。结论针对急诊多发性创伤,应用早期预警评分联合CRAMS评分系统,可增强对病情的评估能力,提高护理措施针对性,进而缩短抢救时间,提高抢救成功率。     

三种创伤评分对于芦山地震伤员在一线医院的院内检伤分类应用价值

目的：探讨院前指数（PHI）,CRAMS及RTS创伤评分（修订创伤记分）应用于地震伤员快速院内检伤分类时,对于评估其伤情危重度的价值。方法：纳入41例芦山地震伤员,均进行PHI,CRAMS及RTS评分,并随访至术后/出院,进行ISS评分。比较各评分与ISS评分的相关性。结果：CRAMS评分与ISS评分相关系数为-9.135（因CRAMS评分法分值越高,伤情越轻）,P〈0.05,差异有统计学意义;同时也发现RTS评分与ISS评分相关系数为10.331,P〈0.05,差异有统计学意义。结论：CRAMS评分对于地震伤员伤情的评估与ISS评分的相关性好,可用于院内急诊的快速检伤分类。     

RTS伤情评分智能生成救治路径在创伤救治中的应用

[目的]探讨修正的创伤记分法(Revised Trauma Score,RTS)伤情评分智能生成救治路径在创伤救治过程中的应用效果。[方法]回顾性分析2018年—2019年在医院治疗的74例创伤病人的临床资料,依据救治过程中是否采用RTS伤情评分智能生成救治路径74例病人分为对照组与观察组,每组37例,对照组未采用RTS伤情评分智能生成救治路径,观察组采用RTS伤情评分智能生成救治路径,比较两组抢救情况、病人满意度与创伤60 min内手术率。[结果]观察组抢救时间、入院至手术时间均短于对照组,观察组病人满意度、抢救成功率与创伤60 min内手术率均高于对照组,经比较差异有统计学意义(P0.05)。[结论]对重症创伤者采用RTS伤情评分智能生成救治路径进行救治,可有效缩短救治时间,提高抢救成功率以及病人满意度。     

ＣＲＡＭＳ 评分法在急诊预检分诊创伤患者的效果分析

目的 探讨 CRAMS 评分法在急诊预检分诊创伤患者抢救中的效果。 方法： 采用历史回顾对照法比较,急诊科在2014-09～2015-09月常规急诊预检分诊创伤患者为133例为对照组,2015 －10～2016 －10月急诊预检CRAMS评分分诊创伤患者113 例为观察组,比较两组患者病情分级的准确率、急救成功例、不良事件发生率结果。 结果 ：与对照组比较,观察组患者病情分级的准确率及抢救室急救成功例数明显升高、急诊科不良事件发生率也明显下降,(P < 0. 05)。 结论 CRAMS 评分法能够对急诊预检分诊创伤患者病情进行临床上的快速评估,准确分诊,提高抢救成功率。     

四种院前创伤评分对急诊创伤患者的评估研究

目的评价四种评分对院前成人创伤患者临床评估的适用性和可行性。方法 284例成人创伤患者现场分别行院前创伤指数评分(TI)、创伤评分(TS)、修正创伤评分(RTS)、CRAMS和创伤严重评分(ISS),追踪患者伤情、去向,回顾性分组统计分析四种评分与患者伤情、去向的相关性及临床价值,并比较对院前创伤患者分流评估能力的优劣。结果不同分组间患者的性别、年龄以及创伤至入院时间比较差异均无统计学意义(P>0.05),患者选择无偏倚;不同伤情的四组间比较时,TI和RTS评分的分值组间两两比较差异均有统计学意义(P<0.05),且TI分值与ISS评分伤情分组呈正相关(r=0.637,P<0.001),RTS分值与ISS评分伤情分组呈负相关(r=-0.477,P<0.001)。不同去向的四组间比较时,TI和CRAMS分值组间两两比较差异均有统计学意义(P<0.05),且TI分值与患者的去向分组呈正相关(r=0.604,P<0.001),CRAMS分值与患者的去向分组呈负相关(r=-0.536,P<0.001);四种评分对患者收住院的分辨度横向比较中,TI分辨度最高,曲线下面积为0.826(P<0.05),最佳截断值为12分,此时的敏感度和特异度分别为61.8%和95.9%;预计住院危险度曲线与实际收住院率曲线吻合度的Hosmer-Lemeshow适合度检验差异无统计学意义(C=13.770,P>0.05)。结论院前TI评分具有应用广泛、操作便捷的优点,适用于创伤患者伤情的快速评估,特别是对合理分流创伤患者的应用价值较高,其预测收住院的最佳截断值为12分。     

基于CRAMS评分法的护理干预对急诊手外伤急救效果与恢复状况的影响

目的探讨基于CRAMS评分法的护理干预对急诊手外伤急救效果与恢复状况的影响。方法选择我院2017年5月至2019年4月收治的急诊手外伤患者98例为研究对象,根据入院单双号等分为对照组和观察组,对照组给予常规护理,观察组实施基于CRAMS评分法的护理干预,比较两组患者急救效果及手功能恢复状况。结果观察组伤情评估正确率高于对照组,急救时间短于对照组(P<0.05);观察组Carroll手功能评分及TAM评分均高于对照组(P<0.05)。结论基于CRAMS评分法的护理干预在急诊手外伤患者中应用,能显著改善急救效果,促进手功能恢复。     

创伤评分法在急诊创伤患者救治中的应用研究

选取2011年11月~2013年9月我院急诊科收治的严重创伤患者49例,在入科时均进行创伤CRAMS评分和ISS评分,分析比较两种评分方法的评价效果。结果死亡患者的ISS评分明显高于存活患者(P0.01),而CRAMS评分低于存活患者(P0.05);ISS评分越高,病死率越高;CRAMS评分越低,创伤患者病死率越高。准确评估严重创伤患者的伤情对指导抢救治疗及预后预测十分重要。     

修正创伤评分结合血红蛋白水平在急诊创伤病人中的应用价值研究

[目的]评估使用修正创伤评分(RTS)结合血红蛋白水平(HB)对急诊创伤病人收住急诊重症监护室(EICU)的预测效果。[方法]回顾性分析2017年9月—2018年9月我院急诊科接诊的324例创伤病人,记录病人就诊时的一般资料,计算RTS,创伤严重程度评分(ISS),循环、呼吸、胸腹、运动和语言评分(CRAMS)。按照ISS评分分为轻伤病人(ISS≤5分)、中伤病人(ISS 6～16分)、重伤病人(ISS 16～25分)、严重伤病人(ISS25分),绘制不同创伤评分评估病人收治EICU的ROC曲线,比较ROC曲线下面积(AUC)的差异。[结果]轻伤组115例,中伤组81例,重伤组66例,严重伤组62例;4组病人HB、RTS评分、CRAMS评分、病人去向比较差异有统计学意义(P0. 01);多因素Logistic回归分析结果显示,HB、RTS评分、CRAMS评分是预测病人需收住EICU的独立危险因素;不同创伤评分的ROC曲线下面积比较显示,RTS结合HB的评估价值最高,灵敏度为85. 0%,特异度为80. 0%。[结论]RTS-HB与原始RTS和CRAMS相比具有更好的预测病人收住EICU的能力。     

改良早期预警评分在急诊患者中的应用

目的 探讨改良早期预警评分在急诊患者中的应用及效果.方法 2012年1-12月,我院采用改良早期预警评分对急诊就急诊患者进行病情评估,根据评估分值,采取相对应的护理措施和流程,并与2011年就急诊患者作对比.结果 2012年急诊的抢救成功率、预检准确率、平均分诊时间及平均急诊时间等方面与2011年比较,差异有统计学意义(P＜0.05).结论 改良早期预警评分评估病情迅速、准确,能提高急救护理的准确性、预见性,提高急诊患者抢救成功率和预检准确率,缩短患者平均分诊时间及急诊时间,对规范及完善急救护理流程有积极意义.     

急诊分诊创伤评估法应用研究

目的 为了探讨埘急诊创伤患者的快速有效评估方法,以防预检分诊时的漏检和误检,延误创伤患者救治.方法 于2006年1月1日至2006年12月31日,采用创伤评估法,即CRAMS评分和创伤评估程序相结合,应用于浙江大学医学院附属第二医院收治的4023例创伤患者的评估.结果 CRAMS<7分(为重伤):2430例;创伤评估程序发现有危及生命的解剖部位伤1979例;值得重视的是:采用创伤评估法发现,在CRAMSi≥>7分的1593例刨伤患者中,仍存在危及生命伤46例.结论 CRAMS法可作为类选;创伤评估程序可作解剖部位损伤的评估;二者结合而成的创伤评估法能弥补相互的缺陷,既能保证重伤患者及时有效的抢救,同时义可合理利用急诊资源.     

The Revised Trauma Score plus serum albumin level improves the prediction of mortality in trauma patients

Introduction

The Revised Trauma Score (RTS) is used worldwide in prehospital practice and in the emergency department (ED) settings to triage trauma patients. The main purpose of this study was to evaluate the value of the RTS plus serum albumin (RTS-A) and to compare it with other existing trauma scores as well as to compare the predictive performance of the Trauma and Injury Severity Score with the RTS-A (TRISS-A) with the original TRISS.

休克指数及CRAMS创伤评分法在腹部闭合伤早期抗休克治疗中的效果研究

目的 验证休克指数及CRAMS创伤评分法的应用在腹部闭合伤患者早期抗休克治疗中效果的研究。方法 (1) 将45例腹部闭合伤患者按随机数字表法分为干预组和对照组,两组均接受腹部闭合伤抗休克常规治疗,干预组按照干预策略既定的方案进行抗休克指数的监测及CRAMS创伤评分法查看两组之间的存活率是否存在统计学差异。（2）回顾45例腹部闭合伤病例,将其分为腹腔出血组和腹腔无出血组,探讨休克指数,CRAMS创伤评分法诊断出血的灵敏度。 结果 (1) 干预组与对照组相比,在腹腔脏器闭合性损伤时把休克指数与CRAMS创伤评分法相结合,与单纯的依靠收缩压和心率相比,在统计学上无明显差异。（2）通过对45例病例2个指标的灵敏度分析,监测休克指数与CRAMS创伤评分法对于判断腹腔内出血的灵敏度高于监测心率和收缩压。 结论 据试验结果我们可以推断：结合休克指数与CRAMS创伤评分法在腹部闭合伤患者抗休克的治疗中较单纯依靠心率和收缩压更具有临床意义。在急诊科,我们可以增加对于腹部闭合伤患者抗休克治疗时的休克指数与CRAMS创伤评分法的监测,可提高对于腹部闭合伤患者的病情判断、指导抢救及预后。     

Comparative performance of the Baxt Trauma Triage Rule.

New methods of deciding which patients require trauma center transport continue to be devised. Baxt recently published a Trauma Triage Rule (TTR) using anatomic injury, blood pressure, and elements of the Glascow Coma scale which can be used to identify adult major trauma patients. The purpose of this study was to compare the TTR against three previously published trauma triage instruments; the Triage-Revised Trauma Score, the Prehospital Index, and the CRAMS scale. We applied these rules to a data base of trauma patients transported by the Cleveland, Ohio Emergency Medical Services System. All four instruments identified adult trauma patients who either died or required emergent operations with sensitivities of at least .85. The specificity of the TTR exceeded that of the CRAMS. We conclude that the TTR is an effective means of identifying patients who either die or require emergent operation.     

The role of the New Trauma and Injury Severity Score (NTRISS) for survival prediction

The objective of this study was to verify if replacing the Injury Severity Score (ISS) by the New Injury Severity Score (NISS) in the original Trauma and Injury Severity Score (TRISS) form would improve the survival rate estimation. This retrospective study was performed in a level I trauma center during one year. ROC curve was used to identify the best indicator (TRISS or NTRISS) for survival probability prediction. Participants were 533 victims, with a mean age of 38±16 years. There was predominance of motor vehicle accidents (61.9%). External injuries were more frequent (63.0%), followed by head/neck injuries (55.5%). Survival rate was 76.9%. There is predominance of ISS scores ranging from 9-15 (40.0%), and NISS scores ranging from 16-24 (25.5%). Survival probability equal to or greater than 75.0% was obtained for 83.4% of the victims according to TRISS, and for 78.4% according to NTRISS. The new version (NTRISS) is better than TRISS for survival prediction in trauma patients.     

Injury Severity Score versus New Injury Severity Score for penetrating injuries

INTRODUCTION: The New Injury Severity Score (NISS) was introduced in 1997 to improve outcome prediction based on anatomical severity scoring in trauma victims. Studies on populations of blunt trauma victims indicate that the NISS, predicts better than the Injury Severity Score (ISS) mortality post-injury, which is why the NISS has been recommended as the new "gold standard" for severity scoring. However, so far the accuracy of the NISS for penetrating injuries has not been validated against the ISS. METHODS: ISS and NISS scores were collected retrospectively for 1,787 war- and landmine victims in North Iraq. All victims only had penetrating injuries. The two tests were compared for prediction of short-term mortality and post-operative complications using Receiver Operating Characteristics (ROC) analysis. RESULTS: Both the ISS and the NISS predicted mortality with high accuracy (ROC area under curve 0.9). There were no significant differences between the two tests. The predictive accuracy for post-operative complications was moderate for both tests (ROC-AUC < 0.8), with the NISS performing significantly better than the ISS. CONCLUSION: The NISS does not perform better than the ISS in penetrating injuries. However, this study was done on a low-risk trauma population, thus the results should not be extrapolated to high severity trauma. Due to statistical shortcomings in studies previously published, studies on far larger cohorts are necessary before the NISS should be adopted as the new "gold standard" for severity scoring.     

Childhood falls: characteristics, outcome, and comparison of the Injury Severity Score and New Injury Severity Score

Objectives

The aim of this study was to determine the general characteristics of childhood falls, factors affecting on mortality, and to compare the Injury Severity Score (ISS) and the New Injury Severity Score (NISS) as predictors of mortality and length of hospital stay in childhood falls.

Methods

We retrospectively analysed over a period of 8 years children aged younger than14 years who had sustained falls and who were admitted to our emergency department. Data on the patients'' age, sex, type of fall, height fallen, arrival type, type of injuries, scoring systems, and outcome were investigated retrospectively. The ISS and NISS were calculated for each patient. Comparisons between ISS and NISS for prediction of mortality were made by receiver operating characteristic (ROC) curve and Hosmer‐Lemeshow (HL) goodness of fit statistics.

Results

In total, there were 2061 paediatric trauma patients. Falls comprised 36 (n = 749) of these admissions. There were 479 male and 270 female patients. The mean (SD) age was 5.01 (3.48) years, and height fallen was 3.8 (3) metres. Over half (56.6%) of patients were referred by other centres. The most common type of fall was from balconies (38.5%), and head trauma was the most common injury (50%). The overall mortality rate was 3.6%. The cut off value for both the ISS and NISS in predicting mortality was 22 (sensitivity 90.5%, specificity 95.4% for ISS; sensitivity 100%, specificity 88.7% for NISS) (p>0.05). Significant factors affecting mortality in logistic regression analysis were Glasgow Coma Scale (GCS) <9, ISS >22, and NISS >22. There were no significant differences in ROC between three scoring systems. The HL statistic showed poorer calibration (p = 0.02 v p = 0.37, respectively) of the NISS compared with the ISS.

Conclusions

In our series, the head was the most frequent site of injury, and the most common type of fall was from balconies. Scores on the GCS, NISS, and ISS are significantly associated with mortality. The performance of the NISS and ISS in predicting mortality in childhood falls was similar.     

3种创伤严重程度评分方法对老年创伤患者院内死亡预测价值的比较研究

目的 比较创伤重度程度评分、老年创伤结局评分以及损伤严重程度评分对老年创伤患者院内死亡风险的预测价值。方法 回顾性分析2011年1月—2019年9月经急诊入院的523例老年创伤患者的临床资料,收集人口学信息、各种评分系统所涉及的项目信息、是否发生院内死亡。采用创伤重度程度评分、老年创伤结局评分以及损伤严重程度评分预测院内死亡的发生情况,通过计算受试者工作特征曲线下面积（AUC）,比较3种评分方法对老年创伤患者发生院内死亡的预测价值。结果 在3个评分系统中,创伤重度程度评分的AUC最高（0.914）,其约登指数、特异度也最高分别为0.716、0.859,表现比较均衡;老年创伤结局评分的敏感度最高（0.971）,但特异度却最低（0.609）。结论 创伤重度程度评分相较创伤结局评分、损伤严重程度评分在预测老年创伤患者院内死亡风险方面效能最好,评估更为全面,更适用于我国急诊早期入院的老年创伤患者的相关评估。