儿童跌倒：损伤严重程度评分与新损伤严重程度评分的特征、结果及比较
Childhood falls: characteristics, outcome, and comparison of the Injury Severity Score and New Injury Severity Score.
作者信息
Bulut M, Koksal O, Korkmaz A, Turan M, Ozguc H
机构信息
Department of Emergency Medicine, Uludag University Medical School, Bursa, Turkey.
出版信息
Emerg Med J. 2006 Jul;23(7):540-5. doi: 10.1136/emj.2005.029439.
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.
目的
本研究旨在确定儿童跌倒的一般特征、影响死亡率的因素，并比较损伤严重度评分（ISS）和新损伤严重度评分（NISS）作为儿童跌倒死亡率和住院时间预测指标的情况。
方法
我们回顾性分析了8年间14岁以下因跌倒而入住我院急诊科的儿童。回顾性调查了患者的年龄、性别、跌倒类型、跌落高度、就诊类型、损伤类型、评分系统和结局等数据。计算每位患者的ISS和NISS。通过受试者工作特征（ROC）曲线和霍斯默-莱梅肖（HL）拟合优度统计量对ISS和NISS预测死亡率进行比较。
结果
共有2061例儿科创伤患者。其中跌倒患者占36%（n = 749）。男性患者479例，女性患者270例。平均（标准差）年龄为5.01（3.48）岁，跌落高度为3.8（3）米。超过一半（56.6%）的患者由其他中心转诊。最常见的跌倒类型是从阳台跌落（38.5%），最常见的损伤是头部创伤（50%）。总死亡率为3.6%。ISS和NISS预测死亡率的临界值均为22（ISS的敏感性为90.5%，特异性为95.4%；NISS的敏感性为100%，特异性为88.7%）（p>0.05）。逻辑回归分析中影响死亡率的显著因素为格拉斯哥昏迷量表（GCS）<9、ISS>22和NISS>22。三种评分系统的ROC曲线无显著差异。HL统计量显示，与ISS相比，NISS的校准效果较差（分别为p = 0.02和p = 0.37）。
结论
在我们的研究系列中，头部是最常见的受伤部位，最常见的跌倒类型是从阳台跌落。GCS、NISS和ISS评分与死亡率显著相关。NISS和ISS在预测儿童跌倒死亡率方面的表现相似。
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