Greys Hospital, Pietermaritzburg, Kwazulu-Natal, South Africa; Edendale Hospital, Pietermaritzburg, Kwazulu-Natal, South Africa; University of Kwazulu-Natal, South Africa; Department of Anaesthetics, Critical Care and Pain Management, South Africa.
Greys Hospital, Pietermaritzburg, Kwazulu-Natal, South Africa; Edendale Hospital, Pietermaritzburg, Kwazulu-Natal, South Africa; Department of Surgery, South Africa.
Am J Surg. 2018 Aug;216(2):235-239. doi: 10.1016/j.amjsurg.2017.07.025. Epub 2017 Aug 30.
Traumatic shock cannot be diagnosed by a single physiological measurement and a number of vital sign based combined shock scores (CSS) have been proposed to identify and triage trauma patients with shock. This audit uses data from a prospectively entered electronic trauma registry to compare the ability of these CSS to predict in-hospital mortality, need for surgery, need for blood transfusion and ICU admission.
The data used in the study was obtained from the Hybrid Electronic Medical Record (HEMR) in Pietermaritzburg from January 2012-September 2015. The calculated scores (Systolic Blood Pressure [SBP], Mean Arterial Pressure [MAP], Shock Index [SI], Modified Shock Index [MSI] and Shock Index multiplied by Age [SIA]) were plotted against each outcome parameter and the inflection points at which they started to increase, for each parameter, was determined and compared.
A total of 8793 patients met the inclusion criteria. After the datasets with missing data were removed, a total of 7623 patients were available for analyses. There was a slightly higher incidence of blunt trauma (46%) compared to penetrating trauma (43%). Area under the Receiver Operating Curves (AUROC) for prediction of mortality revealed the MSI and SIA performed best, with values of 0.69 and 0.70, respectively. In both the 'need for ICU' prediction as well as the 'need for blood transfusion' prediction, MSI performed best with scores of 0.73 and 0.79, respectively. None of the parameters performed well in the 'need for surgery' prediction. None of the CSS parameters reached a 'good predictor capability' score of 0.8.
The currently available vital sign based scores (SBP, MAP, SI, MSI, SIA) used in the prediction of shock severity and triage are not good predictors of mortality, need for ICU, need for theatre or need for blood transfusion in our population where half the trauma is penetrating and there are long pre-hospital delays. Our data suggests that none of the proposed CSS's are capable of reliably and accurately identifying and categorizing shock states in South African trauma patients.
创伤性休克不能仅通过单一的生理测量来诊断，目前已经提出了许多基于生命体征的综合休克评分（CSS）来识别和分诊休克创伤患者。本研究使用前瞻性电子创伤登记数据库中的数据，比较这些 CSS 对住院死亡率、手术需求、输血需求和 ICU 入住率的预测能力。
本研究的数据来源于彼得马里茨堡的混合电子病历（HEMR），时间为 2012 年 1 月至 2015 年 9 月。计算得出的评分（收缩压[SBP]、平均动脉压[MAP]、休克指数[SI]、改良休克指数[MSI]和休克指数乘以年龄[SIA]）与每个结局参数进行比较，并确定每个参数开始增加的拐点，然后进行比较。
共有 8793 例患者符合纳入标准。剔除数据缺失的数据集后，共有 7623 例患者可用于分析。钝性创伤的发生率（46%）略高于穿透性创伤（43%）。预测死亡率的受试者工作特征曲线（ROC）下面积（AUROC）显示，MSI 和 SIA 的表现最佳，分别为 0.69 和 0.70。在预测 ICU 入住需求和输血需求方面，MSI 的表现最佳，其评分分别为 0.73 和 0.79。在预测手术需求方面，没有任何参数表现良好。在预测死亡率、需要 ICU、需要手术、需要输血需求方面，没有任何一个 CSS 评分参数达到 0.8 的“良好预测能力”评分。
目前用于预测休克严重程度和分诊的基于生命体征的评分（SBP、MAP、SI、MSI、SIA）在预测我们人群中的死亡率、ICU 入住需求、手术需求或输血需求方面并不是很好的预测指标，因为我们人群中一半的创伤是穿透性的，而且院前的延迟时间较长。我们的数据表明，在南非创伤患者中，没有一种 CSS 评分能够可靠、准确地识别和分类休克状态。
