Hannan E L, Farrell L S, Meaker P S, Cooper A
Department of Health Policy, Management and Behavior, School of Public Health, State University of New York, University at Albany, Rensselaer, NY, USA.
J Pediatr Surg. 2000 Feb;35(2):155-9. doi: 10.1016/s0022-3468(00)90001-0.
The aim of this study was to identify significant independent predictors of inpatient mortality rates for pediatric victims of blunt trauma and to develop a formula for predicting the probability of inpatient mortality for these patients.
Emergency department and inpatient data from 2,923 pediatric victims of blunt injury in the New York State Trauma Registry in 1994 and 1995 were used to explore the relationship between patient risk factors and mortality rate. A stepwise logistic regression model with P<.05 was developed using survival status asthe dependent variable. Independent variables included are elements of the Pediatric Trauma Score (PTS), additional elements from the Revised Trauma Score (RTS), the motor response and eye opening components of the Glasgow Coma Scale (GCS), age-specific systolic blood pressure, the AVPU score, and 2 measures of anatomic injury severity (the Injury Severity Score [ISS] and the International Classification of Disease, Ninth Revision-based Injury Severity Score [ICISS]).
The only significant independent predictors of severity that emerged were the ICISS, no motor response (best motor response = 1) from the GCS, and the unresponsive component from the AVPU score. The statistical model exhibited an excellent fit (C statistic = .964). The specificity associated with the prediction of inpatient mortality rate based on the presence of 1 or more of these risk factors was .926, and the sensitivity was .944.
The best independent predictors of inpatient mortality rate for pediatric trauma patients with blunt injuries include variables not specifically contained in the PTS or the RTS: ICISS, no motor response (best motor response = 1) from the GCS, and the unresponsive component of the AVPU score.
本研究旨在确定钝性创伤儿科患者住院死亡率的显著独立预测因素，并制定一个预测这些患者住院死亡概率的公式。
利用1994年和1995年纽约州创伤登记处2923例钝性损伤儿科患者的急诊科和住院数据，探讨患者风险因素与死亡率之间的关系。以生存状态作为因变量，建立了P<0.05的逐步逻辑回归模型。自变量包括儿科创伤评分（PTS）的要素、修订创伤评分（RTS）的其他要素、格拉斯哥昏迷量表（GCS）的运动反应和睁眼成分、特定年龄的收缩压、AVPU评分以及两种解剖损伤严重程度的测量指标（损伤严重程度评分[ISS]和基于国际疾病分类第九版的损伤严重程度评分[ICISS]）。
出现的唯一显著独立严重程度预测因素是ICISS、GCS中无运动反应（最佳运动反应=1）以及AVPU评分中的无反应成分。统计模型显示拟合良好（C统计量=0.964）。基于存在1个或更多这些风险因素预测住院死亡率的特异性为0.926，敏感性为0.944。
钝性损伤儿科创伤患者住院死亡率的最佳独立预测因素包括PTS或RTS中未具体包含的变量：ICISS、GCS中无运动反应（最佳运动反应=1）以及AVPU评分中的无反应成分。
