Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea; Department of Emergency Medicine, Myongji Hospital, 55, Hwasu-ro 14beon-gil, Deogyang-gu, Goyang-si, Gyeonggi-do 10475, South Korea.
Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea; Department of Emergency Medicine, Chungbuk National University Hospital, 776, 1sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do 28644, South Korea.
Am J Emerg Med. 2018 Feb;36(2):257-261. doi: 10.1016/j.ajem.2017.07.091. Epub 2017 Jul 31.
This study aimed to validate the criteria for early critical care resource (CCR) use as an outcome predictor for seriously injured patients triaged in the field by comparing the effectiveness of the criteria for early CCR use with that of criteria defined by an Injury Severity Score (ISS) >15.
We analysed data from seriously injured trauma patients who were triaged using a field triage protocol by emergency medical service providers (EMS-ST patients). Early CCR use was defined as the use of any of the following treatment modalities or outcomes: advanced airway management, blood transfusion, or interventional radiology (<4h), emergency operation or cardiopulmonary resuscitation, or thoracotomy (<24h), or admission for spinal cord injury. The primary endpoint was inhospital mortality. We generated area under the receiver operating characteristic (AUROC) curves to compare the value of the early CCR use criteria with that of the ISS >15 criteria in the discrimination between survivors and non-survivors.
Of the 14,352 adult EMS-ST patients, 9299 were enrolled in this study. Approximately 19.6% required early CCR use, and 18.0% had an ISS >15. The rate of in-hospital mortality was 9.4%. The AUROC values for the performances of the early CCR use and ISS>15 criteria in the prediction of in-hospital mortality were 0.89 (95% confidence interval [CI] 0.85-0.91) and 0.84 (95% CI 0.79-0.86), respectively (p<0.01).
The early CCR use criteria demonstrated better performance than the ISS >15 criteria in the prediction of mortality in EMS-ST patients.
本研究旨在通过比较早期关键资源（CCR）使用标准与损伤严重程度评分（ISS）>15 的标准对现场分诊的严重创伤患者的预后预测效果，验证早期 CCR 使用标准作为结局预测因子的标准。
我们分析了使用急救医疗服务提供者（EMS-ST）现场分诊方案分诊的严重创伤患者的数据。早期 CCR 使用定义为使用以下任何治疗方式或结局：高级气道管理、输血或介入放射学（<4 小时）、急诊手术或心肺复苏或开胸术（<24 小时）或脊髓损伤住院。主要终点是院内死亡率。我们生成了受试者工作特征（ROC）曲线下面积（AUROC），以比较早期 CCR 使用标准与 ISS>15 标准在区分幸存者和非幸存者方面的价值。
在 14352 名成人 EMS-ST 患者中，有 9299 名患者纳入本研究。约 19.6%需要早期 CCR 使用，18.0%ISS>15。院内死亡率为 9.4%。早期 CCR 使用和 ISS>15 标准预测院内死亡率的 AUROC 值分别为 0.89（95%置信区间[CI]0.85-0.91）和 0.84（95%CI 0.79-0.86）（p<0.01）。
与 ISS>15 标准相比，早期 CCR 使用标准在预测 EMS-ST 患者死亡率方面表现更好。
