将全身炎症反应综合征纳入多发伤定义的实用性：一家一级创伤中心的经验。
The practicality of including the systemic inflammatory response syndrome in the definition of polytrauma: experience of a level one trauma centre.
机构信息
Department of Traumatology, Division of Surgery, John Hunter Hospital, University of Newcastle, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW 2300, Australia.
出版信息
Injury. 2013 Jan;44(1):12-7. doi: 10.1016/j.injury.2012.04.019. Epub 2012 May 17.
BACKGROUND
The systemic inflammatory response syndrome (SIRS) has been advocated as a significant predictor of outcome in trauma. Recent trauma literature has proposed SIRS as a surrogate for physiological derangements characteristic of polytrauma with some authors recommending its inclusion into the definition of polytrauma. The practicality of daily SIRS collection outside of specifically designed prospective trials is unknown. The purpose of this study was to assess the availability of SIRS variables and its appropriateness for inclusion into a definition of polytrauma. We hypothesised SIRS variables would be readily available and easy to collect, thus represent an appropriate inclusion into the definition of polytrauma.
METHOD
A prospective observational study of all trauma team activation patients over 7-months (August 2009 to February 2010) at a University affiliated level-1 urban trauma centre. SIRS data (temperature>38°C or <36°C; Pulse >90 bpm; RR>20/min or a PaCO(2)<32 mmHg; WCC>12.0×10(9)L(-1), or <4.0×10(9)L(-1), or the presence of >10 immature bands) collected from presentation, at 24 h intervals until 72 h post injury. Inclusion criteria were all patients generating a trauma team activation response age >16.
RESULTS
336 patients met inclusion criteria. In 46% (155/336) serial SIRS scores could not be calculated due to missing data. Lowest rates of missing data observed on admission [3% (11/336)]. Stratified by ISS>15 (132/336), in 7% (9/132) serial SIRS scores could not be calculated due to missing data. In 123 patients ISS>15 with complete data, 81% (100/123) developed SIRS. For Abbreviated Injury Scale (AIS)>2 in at least 2 body regions (64/336) in 5% (3/64) serial SIRS scores could not be calculated, with 92% (56/61) of patients with complete data developing SIRS. For Direct ICU admissions [25% (85/336)] 5% (4/85) of patients could not have serial SIRS calculated [mean ISS 15(±11)] and 90% (73/81) developed SIRS at least once over 72 h.
CONCLUSION
Based on the experience of our level-1 trauma centre, the practicability of including SIRS into the definition of polytrauma as a surrogate for physiological derangement appears questionable even in prospective fashion.
背景
全身炎症反应综合征（SIRS）已被认为是创伤后预后的重要预测指标。最近的创伤文献提出 SIRS 可以作为创伤后生理紊乱的替代指标，一些作者建议将其纳入多发伤的定义中。目前尚不清楚在专门设计的前瞻性试验之外，日常收集 SIRS 变量的实用性。本研究旨在评估 SIRS 变量的可用性及其纳入多发伤定义的适宜性。我们假设 SIRS 变量易于获得和收集，因此代表了纳入多发伤定义的适宜性。
方法
这是一项在大学附属的一级城市创伤中心对所有创伤团队激活患者进行的前瞻性观察研究，时间为 7 个月（2009 年 8 月至 2010 年 2 月）。从患者就诊时开始收集 SIRS 数据（体温>38°C 或<36°C；脉搏>90 次/分；呼吸频率>20 次/分或 PaCO2<32mmHg；白细胞计数>12.0×109/L 或<4.0×109/L 或有>10%的不成熟细胞），然后在 24 小时和 72 小时间隔内进行监测。纳入标准为所有年龄大于 16 岁的创伤团队激活患者。
结果
336 名患者符合纳入标准。在 46%（155/336）的患者中，由于数据缺失，无法计算连续 SIRS 评分。入院时观察到最低的数据缺失率为 3%（11/336）。根据 ISS>15（132/336）进行分层，在 7%（9/132）的患者中，由于数据缺失，无法计算连续 SIRS 评分。在 123 名 ISS>15 且数据完整的患者中，有 81%（100/123）发生了 SIRS。对于至少有 2 个身体区域的 AIS>2（336 例中的 64 例），在 5%（3/64）的患者中无法计算连续 SIRS 评分，在 61 例数据完整的患者中，有 92%（56/61）发生了 SIRS。对于直接 ICU 入院患者（25%，85/336），有 5%（4/85）的患者无法计算连续 SIRS，平均 ISS 为 15（±11），90%（73/81）的患者在 72 小时内至少发生过一次 SIRS。
结论
根据我们的一级创伤中心的经验，即使采用前瞻性方法，将 SIRS 纳入多发伤定义作为生理紊乱的替代指标的实用性似乎也值得怀疑。
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