State University of New York, Downstate Medical Center, Brooklyn, NY.
West J Emerg Med. 2010 Dec;11(5):450-5.
To test the diagnostic use of the triage white blood cell (WBC) count in differentiating major from minor injuries.
We conducted a retrospective study of a prospectively collected database of trauma patients 13 years of age or older at a Level I trauma center from January 2005 through December 2008. We excluded all patients with obvious life-threatening injuries requiring immediate surgery, isolated head trauma, transferred from another institution or dead on arrival. We recorded age, sex, injury mechanism, vital signs, WBC, base deficit (BD), lactate (LAC) and calculated injury severity scores (ISS). Major injury was defined as either a change in hematocrit >10 points or blood transfused within 24 hours, or ISS >15.
805 patients were included in the study with an average age of 38.6 years (Range 13-95 yrs) years. 75.3% of patients were male, 45.6% had blunt and 34.4% had penetrating trauma. For vital signs, blood pressure was not significantly different between major and minor injury patients. Major compared to minor injury patients had a statistically but not clinically significant higher heart rate. Major injury patients had significantly (p < 0.0001) higher WBC count (10.53 K/μl, 95% CI: 9.7-11.3) compared to patients with minor injuries (8.92 K/μl, 95% CI: 8.7-9.2), but both were in the normal range. Patients with major compared to minor injury had significantly (p < 0.0001) higher BD (-3.1 versus -0.027 mmol/L) and higher LAC (3.9 versus 2.48 mmol/L). Areas under the curve for WBC count (0.60, 95% CI: 0.54-0.66) are similar to BD (0.69, 95% CI: 0.63-0.74) and LAC (0.66, 95% CI: 0.60-0.71).
WBC count is not a useful addition as a diagnostic indicator of major trauma in our study population.
检验创伤分诊时白细胞计数对鉴别轻伤与重伤的诊断价值。
我们对一家创伤中心 2005 年 1 月至 2008 年 12 月期间收治的 13 岁及以上的创伤患者前瞻性数据库进行了回顾性研究。我们排除了所有需要立即手术治疗、单纯头部创伤、从其他医疗机构转来或到院时已经死亡的有明显生命威胁的患者。我们记录了患者的年龄、性别、损伤机制、生命体征、白细胞计数、碱缺失（BD）、乳酸（LAC）并计算了损伤严重程度评分（ISS）。重伤定义为：红细胞压积变化>10 个点或 24 小时内输血，或 ISS>15。
本研究共纳入 805 例患者，平均年龄 38.6 岁（范围 13-95 岁）。75.3%的患者为男性，45.6%为钝性伤，34.4%为穿透伤。在生命体征方面，血压在重伤和轻伤患者之间无显著差异。与轻伤患者相比，重伤患者的心率有统计学但无临床意义上的升高。白细胞计数方面，重伤患者显著高于轻伤患者（10.53 K/μl，95%CI：9.7-11.3），但均处于正常范围（p<0.0001）。与轻伤患者相比，重伤患者的碱缺失（-3.1 比-0.027mmol/L）和乳酸（3.9 比 2.48mmol/L）显著更高（p<0.0001）。白细胞计数（0.60，95%CI：0.54-0.66）、碱缺失（0.69，95%CI：0.63-0.74）和乳酸（0.66，95%CI：0.60-0.71）的曲线下面积相似。
在本研究人群中，白细胞计数不能作为诊断重伤的有用指标。
