Bamvita Jean-Marie, Bergeron Eric, Lavoie Andre, Ratte Sebastien, Clas David
Charles-LeMoyne Hospital, Greenfield Park, Canada.
J Trauma. 2007 Jul;63(1):135-41. doi: 10.1097/TA.0b013e318068651d.
BACKGROUND: This study was designed to show the importance of age, presence of premorbid conditions, and the type of injury on time and location of adult inhospital trauma mortality. METHODS: All acute blunt trauma deaths at a Level I urban trauma center between April 1, 1993 and March 31, 2003 were individually reviewed to collect data on the following variables: age, gender, presence and number of premorbid conditions, mechanisms of trauma, location of death, acute transfer from another hospital, delay to death, initial Glasgow Coma Score (GCS), Abbreviated Injury Score (AIS), Injury Severity Score (ISS), and revised trauma score (RTS). Bivariate analysis using simple logistic regression was used to show the association between each variable and delay to death. Variables significantly associated with death underwent multivariate analysis to yield adjusted odds ratios (aORs) with 95% confidence interval (CI). RESULTS: During the study period there were 463 blunt trauma deaths (6.8%). Their mean age was 67.5 years, mean ISS was 22.6, mean GCS was 11.0, and 55.3% were male. Most deaths occurred in either the intensive care unit (45.8%) or the ward (46.4%); there were few deaths in the emergency department (6.8%) or the operating room (0.4%). The following were significant bivariate predictors for death: presence of premorbid conditions, number of premorbid conditions, age >60, pulmonary diseases, cardiac diseases, diabetes mellitus, neurologic diseases, GCS, AIS > or =4, and ISS. Multivariate analysis demonstrated the following significant findings: patients with severe thoracic injuries were significantly more likely to die in the first 6 hours (aOR = 1.37; CI = 1.12-1.68; p = 0.002); and patients with severe head injuries were more likely to die after 48 hours (aOR = 1.275; CI = 1.158-1.405; p = 0.0001). Older patients and those with neurologic diseases were more likely to die later and in a hospital ward (aOR = 2.18; CI = 1.25-3.81; p = 0.006). Men and women differed as to age, ISS, mechanism of injury, and type of injury, but not as to delay to death. CONCLUSIONS: Age, body area injured, and presence and type of premorbid conditions are significant predictors of location of and delay to death after blunt trauma. We think that incorporating information on premorbid conditions is essential for mortality analysis in an aging population.
背景：本研究旨在表明年龄、病前状况的存在以及损伤类型对成年住院创伤患者死亡时间和地点的重要性。 方法：对1993年4月1日至2003年3月31日期间一级城市创伤中心所有急性钝性创伤死亡病例进行逐一回顾，以收集以下变量的数据：年龄、性别、病前状况的存在及数量、创伤机制、死亡地点、从另一家医院的急性转诊、死亡延迟时间、初始格拉斯哥昏迷评分（GCS）、简明损伤评分（AIS）、损伤严重程度评分（ISS）和修正创伤评分（RTS）。使用简单逻辑回归进行双变量分析，以显示每个变量与死亡延迟之间的关联。与死亡显著相关的变量进行多变量分析，以得出调整后的比值比（aOR）及95%置信区间（CI）。 结果：在研究期间，有463例钝性创伤死亡病例（6.8%）。他们的平均年龄为67.5岁，平均ISS为22.6，平均GCS为11.0，55.3%为男性。大多数死亡发生在重症监护病房（45.8%）或病房（46.4%）；急诊室（6.8%）或手术室（0.4%）的死亡病例很少。以下是死亡的显著双变量预测因素：病前状况的存在、病前状况的数量、年龄>60岁、肺部疾病、心脏病、糖尿病、神经系统疾病、GCS、AIS>或=4以及ISS。多变量分析显示了以下显著结果：严重胸部损伤患者在最初6小时内死亡的可能性显著更高（aOR = 1.37；CI = 1.12 - 1.68；p = 0.002）；严重头部损伤患者在48小时后死亡的可能性更高（aOR = 1.275；CI = 1.158 - 1.405；p = 0.0001）。老年患者和患有神经系统疾病的患者更有可能在后期且在医院病房死亡（aOR = 2.18；CI = 1.25 - 3.81；p = 0.006）。男性和女性在年龄、ISS、损伤机制和损伤类型方面存在差异，但在死亡延迟方面没有差异。 结论：年龄、受伤身体部位以及病前状况的存在和类型是钝性创伤后死亡地点和延迟时间的重要预测因素。我们认为，纳入病前状况信息对于老年人群的死亡率分析至关重要。
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