印度一家一级创伤护理中心创伤性脊柱损伤患者的死亡率概况。
Mortality profile of patients with traumatic spinal injuries at a level I trauma care centre in India.
作者信息
Lalwani S, Singh V, Trikha V, Sharma V, Kumar S, Bagla R, Aggarwal D, Misra M C
机构信息
Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
出版信息
Indian J Med Res. 2014 Jul;140(1):40-5.
BACKGROUND & OBJECTIVES: There is no national spinal trauma registry available in India at present and the research on epidemiology of these injuries is also very limited. The purpose of this study was to describe the mortality profile of patients with spinal injuries brought to a level I trauma centre in India, and to understand the predictive factors which identify patients at an increased risk of spinal trauma mortality.
METHODS
Retrospective data were collected from computerized patients records and autopsy reports maintained in the department of Forensic Medicine. All the cases with spinal injuries whether in isolation or as a part of polytrauma were reviewed. A total of 341 such cases were identified between January 2008 to December 2011. The demographic data, type of trauma, duration of survival, body areas involved, level of spinal injury and associated injuries if any, were recorded.
RESULTS
There were 288 (84.45%) males and 53 (15.55%) females. Most victims (73%) were between 25 and 64 yr of age, followed by young adults between 16 and 24 yr (19.35%). Male: female ratio was 5.4:1. Fifty five per cent cases had spinal injuries in isolation. Injury to the cervical spine occurred in 259 (75.95%) patients, thoracic spine in 56 (16.42%) and thoraco-lumbar spine in 26 (7.62%) patients. The commonest cause of injury was high energy falls (44.28%), followed by road traffic accidents (41.93%). The majority of deaths (51.6%) occurred in the phase IV (secondary to tertiary complications of trauma, i.e. >1 wk). Forty patients died in phase I (brought dead or surviving <3 h), 55 in phase II (>3 to 24 h) and 70 in phase III (> 24 h to 7 days).
INTERPRETATION & CONCLUSIONS: Our data suggest that there is an urgent need to take steps to prevent major injuries, strengthen the pre-hospital care, transportation network, treatment in specialized trauma care units and to improve injury surveillance and the quality of data collected which can guide prevention efforts to avoid loss of young active lives.
背景与目的
目前印度尚无全国性的脊柱创伤登记系统，且关于此类损伤的流行病学研究也非常有限。本研究的目的是描述送至印度一家一级创伤中心的脊柱损伤患者的死亡率情况，并了解可识别脊柱创伤死亡风险增加患者的预测因素。
方法
从法医学系保存的计算机化患者记录和尸检报告中收集回顾性数据。对所有脊柱损伤病例进行审查，无论其为孤立性损伤还是作为多发伤的一部分。2008年1月至2011年12月期间共识别出341例此类病例。记录人口统计学数据、创伤类型、生存时间、受累身体部位、脊柱损伤水平以及是否存在相关损伤。
结果
男性288例（84.45%），女性53例（15.55%）。大多数受害者（73%）年龄在25至64岁之间，其次是16至24岁的年轻人（19.35%）。男女比例为5.4:1。55%的病例为孤立性脊柱损伤。259例（75.95%）患者发生颈椎损伤，56例（16.42%）发生胸椎损伤，26例（7.62%）发生胸腰椎损伤。最常见的损伤原因是高能量坠落（44.28%），其次是道路交通事故（41.93%）。大多数死亡（51.6%）发生在第四阶段（继发于创伤的三级并发症，即>1周）。40例患者在第一阶段死亡（送达时已死亡或存活<3小时），55例在第二阶段死亡（>3至24小时），70例在第三阶段死亡（>24小时至7天）。
解读与结论
我们的数据表明，迫切需要采取措施预防重大损伤，加强院前护理、交通网络、在专业创伤护理单位的治疗，并改善损伤监测以及所收集数据的质量，这可以指导预防工作以避免年轻活跃生命的丧失。
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