Böhmer Andreas B, Just Katja S, Lefering Rolf, Paffrath Thomas, Bouillon Bertil, Joppich Robin, Wappler Frank, Gerbershagen Mark U
Crit Care. 2014 Jul 7;18(4):R143. doi: 10.1186/cc13976.
There are many potential influencing factors that affect the duration of intensive care treatment for patients who have survived multiple trauma. Yet the respective factors' relevance to ICU length of stay (LOS) has been rarely studied. Thus, the aim of the present study was to investigate to what extent specific factors influence ICU LOS in surviving trauma patients.
We retrospectively analyzed a dataset of 30,157 surviving trauma patients from the TraumaRegister DGU® who were older than six years of age and received subsequent intensive care treatment for more than one day, from 2002 to 2011. Univariate analysis and multiple linear regression analysis were used to examine 25 categorical pre- and post-trauma parameters.
Univariate analysis confirmed the impact of all analyzed factors. In subsequent multiple linear regression analyses, coefficients ranged from -1.3 to +8.2 days. The factors that influenced the prolongation of ICU LOS most were renal failure (+8.1 days), sepsis (+7.8 days) and respiratory failure (+4.9 days). Patients spent one additional day in the ICU for every 5 additional points on the Injury Severity Score (regression coefficient +0.2 per point). Furthermore, massive transfusion (+3.3 days), invasive ventilation (+3.1 days), and an initial Glasgow Coma Scale score ≤8 (+3.0 days) had a significant impact on ICU LOS. The coefficient of determination for the model was 44% (R2).
Treatment regimens, as well as secondary effects and complications of trauma and intensive care treatment, prolong ICU LOS more than the mechanism of trauma or pre-trauma patient conditions. Successful prevention of complicated courses of illness, such as sepsis and renal and respiratory failure, could significantly abbreviate the ICU stay in trauma patients. Therefore, the staff's attention should be focused on preventive strategies.
对于多发伤幸存者，有许多潜在影响因素会影响其重症监护治疗的时长。然而，各因素与重症监护病房住院时间（LOS）的相关性鲜有研究。因此，本研究的目的是调查特定因素在多大程度上影响创伤幸存者的重症监护病房住院时间。
我们回顾性分析了创伤注册数据库DGU®中2002年至2011年间年龄大于6岁且接受了超过一天后续重症监护治疗的30157例创伤幸存者的数据集。采用单因素分析和多元线性回归分析来检验25个创伤前后的分类参数。
单因素分析证实了所有分析因素的影响。在随后的多元线性回归分析中，系数范围为-1.3至+8.2天。对重症监护病房住院时间延长影响最大的因素是肾衰竭（+8.1天）、脓毒症（+7.8天）和呼吸衰竭（+4.9天）。损伤严重程度评分每增加5分，患者在重症监护病房多待一天（回归系数为每分+0.2）。此外，大量输血（+3.3天）、有创通气（+3.1天）以及初始格拉斯哥昏迷量表评分≤8（+3.0天）对重症监护病房住院时间有显著影响。该模型的决定系数为44%（R2）。
治疗方案以及创伤和重症监护治疗的继发效应及并发症比创伤机制或创伤前患者状况更能延长重症监护病房住院时间。成功预防诸如脓毒症、肾衰竭和呼吸衰竭等复杂病程可显著缩短创伤患者的重症监护病房住院时间。因此，工作人员应将注意力集中在预防策略上。
