Majercik Sarah, Knight Stacey, Horne Benjamin D
Division of Trauma Services and Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA.
Intermountain Heart Institute, Intermountain Medical Center, Murray, UT, USA, Genetic Epidemiology Division, Department of Medicine, University of Utah, Salt Lake City, UT, USA.
J Crit Care. 2014 Oct;29(5):882.e1-4. doi: 10.1016/j.jcrc.2014.03.016. Epub 2014 Mar 26.
Intermountain Risk Score (IMRS) uses the admission complete blood count and basic metabolic profile to predict mortality. Intermountain Risk Score has been validated in medical patients but has not been evaluated in trauma. This study tested whether IMRS is predictive of mortality in a trauma population at a level I trauma center.
Admitted trauma patients with complete blood count and basic metabolic profile from October 2005 to December 2011 were evaluated. Thirty-day and 1-year IMRS were calculated using multivariable modeling. Mortality was determined using the medical record and Social Security Administration death data.
Three thousand six hundred thirty-seven females and 5901 males were evaluated. Intermountain Risk Score was highly predictive of death at 30 days (c-statistics, c = 0.772 for females; c = 0.783 males) and 1 year (c = 0.778 for females; c = 0.831 males). Cox regression analysis, adjusted for injury severity score, blunt vs penetrating, and length of stay, showed increased mortality risks among patients in the moderate- and high-risk IMRS-defined groups at both 30 days and 1 year, with hazard ratios ranging from 4.96 to 57.88 (all P < .001).
Intermountain Risk Score strongly predicts mortality in trauma patients at this single level I trauma center. The ability to accurately determine a patient's mortality risk at admission makes IMRS a potentially clinically important tool.
山间风险评分(IMRS)利用入院时的全血细胞计数和基本代谢指标来预测死亡率。山间风险评分已在内科患者中得到验证,但尚未在创伤患者中进行评估。本研究测试了IMRS在一级创伤中心的创伤患者群体中是否能预测死亡率。
对2005年10月至2011年12月入院的有全血细胞计数和基本代谢指标的创伤患者进行评估。使用多变量模型计算30天和1年的IMRS。通过病历和社会保障管理局的死亡数据确定死亡率。
共评估了3637名女性和5901名男性。山间风险评分对30天(女性的c统计量,c = 0.772;男性的c = 0.783)和1年(女性的c = 0.778;男性的c = 0.831)的死亡具有高度预测性。经损伤严重程度评分、钝性伤与穿透伤以及住院时间调整后的Cox回归分析显示,在30天和1年时,IMRS定义的中、高风险组患者的死亡风险增加,风险比范围为4.96至57.88(所有P <.001)。
在这家单一的一级创伤中心,山间风险评分能强烈预测创伤患者的死亡率。在入院时准确确定患者死亡风险的能力使IMRS成为一种潜在的临床重要工具。