Department of Surgery, University of Arizona, Tucson, Arizona, USA.
J Surg Res. 2013 Sep;184(1):414-21. doi: 10.1016/j.jss.2013.05.099. Epub 2013 Jun 21.
BACKGROUND: Non-compressible torso hemorrhage (NCTH) is the leading cause of potentially preventable death in military trauma, but the civilian epidemiology is unknown. The aim of this study is to apply a military definition of NCTH, which incorporates anatomic and physiological criteria, to a civilian population treated at trauma centers in the US. METHODS: Patients (age >16 y) from 197 Level 1 trauma centers (approximately 95% of all US Level 1 centers) in the National Trauma Data Bank 2007-2009 that sustained a named torso vessel injury, pulmonary injury, grade IV solid organ injury, or pelvic fracture with ring disruption were included. Of these, patients with a systolic blood pressure <90 mmHg were considered to have NCTH. Multivariable logistic regression was used to identify patient and injury factors associated with NCTH and mortality after adjusting for the following covariates: patient (age, gender, ethnicity, and insurance status), injury (Glasgow Coma Scale, injury type, Injury Severity Score, anatomic region), and clinical (major surgical procedure, need for transfusion, and intensive care unit admission) characteristics. RESULTS: Of the 1.8 million patients in the 2007-2009 National Trauma Data Bank, 249,505 met the anatomic criteria for non-compressible torso injury (NCTI). Of these, 20,414 (8.2%) patients had associated hemorrhage. The rate of pulmonary and torso vessel injury was similar (53.4% and 50.6%, respectively), with solid organ injury identified in 27.0% of patients and pelvic injury in 8.9%. The overall mortality rate of patients with NCTI and NCTH was 6.8% and 44.6%, respectively. The most lethal injury was major torso vessel injury (OR 1.54, 95% CI 1.33-1.78), followed by pulmonary injury (OR 1.32, 95% CI 1.18-1.48). Lower mortality was found in patients with pelvic injury (OR 0.80, 95% CI 0.65-0.98). CONCLUSIONS: The military definition of NCTH can be usefully applied to civilians to identify patients with lethal injuries and high resource needs. Investigating the implications of NCTH on patient triage is recommended.
背景：非压迫性躯干出血（NCTH）是导致军事创伤中潜在可预防死亡的主要原因，但在平民中的流行病学情况尚不清楚。本研究的目的是将一种军事定义的 NCTH 应用于美国创伤中心治疗的平民人群，该定义结合了解剖学和生理学标准。
方法：纳入了 2007 年至 2009 年国家创伤数据库中 197 个 1 级创伤中心（约占所有美国 1 级中心的 95%）中年龄大于 16 岁的患者，这些患者发生了命名的躯干血管损伤、肺损伤、IV 级实质器官损伤或骨盆环破裂的骨盆骨折。其中，收缩压<90mmHg 的患者被认为患有 NCTH。多变量逻辑回归用于确定与 NCTH 相关的患者和损伤因素，并在调整以下协变量后评估死亡率：患者（年龄、性别、种族和保险状况）、损伤（格拉斯哥昏迷评分、损伤类型、损伤严重程度评分、解剖区域）和临床（主要手术、需要输血和重症监护病房入院）特征。
结果：在 2007 年至 2009 年国家创伤数据库的 180 万患者中，有 249505 名患者符合非压缩性躯干损伤的解剖标准（NCTI）。其中，20414 名（8.2%）患者有相关出血。肺和躯干血管损伤的发生率相似（分别为 53.4%和 50.6%），27.0%的患者有实质器官损伤，8.9%的患者有骨盆损伤。NCTI 和 NCTH 患者的总体死亡率分别为 6.8%和 44.6%。最致命的损伤是主要躯干血管损伤（OR 1.54，95%CI 1.33-1.78），其次是肺损伤（OR 1.32，95%CI 1.18-1.48）。骨盆损伤患者的死亡率较低（OR 0.80，95%CI 0.65-0.98）。
结论：可以将军事定义的 NCTH 有效地应用于平民，以识别有致命性损伤和高资源需求的患者。建议研究 NCTH 对患者分诊的影响。
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