Department of General Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
Department of Chinese Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan.
PLoS One. 2018 Mar 20;13(3):e0194749. doi: 10.1371/journal.pone.0194749. eCollection 2018.
Here we conducted a retrospective analysis of hospital-based trauma registry database for evaluating the impacts of comorbidities on the prognosis for traumatized patients using Index of Coexistent Comorbidity Disease (ICED) scores. We analyzed the data of patients with blunt trauma who visited emergency department between January 1, 2011, and December 31, 2015 in Chang-Gung Memorial Hospital, Keelung branch, a single level I trauma center in the Northern Taiwan. All consecutive patients with blunt trauma who admitted to the intensive care unit or ordinary ward after initial managements in the emergency department were included. We measured the hospital mortality of blunt traumatized patients using alive discharge as a competing risk. To investigate conditional independence of mortality and ICED scores given Injury Severity Score (ISS), we used log-linear models for modeling independence structures. Overall, we included 4997 patients (median age [IQR], 59 years old (44-75 years); 55.3% male). The mortality rate of blunt traumatized patients was higher in the higher ICED scores group compared to lower ICED scores group (4.7% vs 1.8%, p < 0.001). Meanwhile, the higher ICED scores group were associated with older age, higher ISS, and longer hospital stay than lower ICED scores group. Higher ICED group had higher probability of transition-to-death and lower probability of transition-to-discharge under the competing risk model. In the multivariable analysis of transition-specific Cox models, higher ICED group were associated with higher risk for hospital mortality compared to lower ICED group (HR 1.60; [95% CI 1.04-2.47]; p = 0.032). Also, higher ICED group were associated with lower probability of transition-to-discharge (HR 0.79; [95%CI 0.73-0.86]; p < 0.001). Additionally, higher ICED scores accounted for hospital mortality among patients with ISS < 25. In conclusion, our study suggested that severity of comorbidity was associated with higher hospital mortality among traumatized patients, particularly lower ISS.
在这里,我们回顾性分析了医院创伤登记数据库,使用合并症指数(ICED)评分评估合并症对创伤患者预后的影响。我们分析了 2011 年 1 月 1 日至 2015 年 12 月 31 日期间在台湾北部一级创伤中心基隆长庚纪念医院急诊就诊的钝器伤患者的数据。所有连续的钝器伤患者,在急诊初始治疗后入住重症监护病房或普通病房,均纳入本研究。我们使用存活出院作为竞争风险来衡量钝器伤患者的院内死亡率。为了研究死亡率和 ICED 评分与损伤严重度评分(ISS)之间的条件独立性,我们使用对数线性模型来建立独立性结构。总体而言,我们纳入了 4997 名患者(中位数年龄[IQR],59 岁(44-75 岁);55.3%为男性)。与 ICED 评分较低的患者相比,ICED 评分较高的患者死亡率更高(4.7%比 1.8%,p<0.001)。同时,ICED 评分较高的患者较 ICED 评分较低的患者年龄更大、ISS 更高、住院时间更长。在竞争风险模型下,ICED 评分较高的患者向死亡转移的概率更高,向出院转移的概率更低。在特定转移的 Cox 模型多变量分析中,与 ICED 评分较低的患者相比,ICED 评分较高的患者与院内死亡风险更高相关(HR 1.60;[95%CI 1.04-2.47];p=0.032)。此外,ICED 评分较高的患者向出院转移的概率更低(HR 0.79;[95%CI 0.73-0.86];p<0.001)。此外,ICED 评分较高与 ISS<25 的患者的院内死亡率相关。总之,我们的研究表明,合并症的严重程度与创伤患者的院内死亡率较高相关,尤其是 ISS 较低的患者。
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