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一种新的简化解剖创伤死亡率评分的制定和验证。

Development and validation of a new simplified anatomic trauma mortality score.

机构信息

General Surgery Department, Hospital Sultanah Aminah, Johor Bahru, Malaysia; Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Malaysia.

General Surgery Department, Hospital Sultanah Aminah, Johor Bahru, Malaysia.

出版信息

Injury. 2019 May;50(5):1125-1132. doi: 10.1016/j.injury.2019.01.027. Epub 2019 Jan 17.


DOI:10.1016/j.injury.2019.01.027
PMID:30686543
Abstract

BACKGROUND: Most trauma mortality prediction scores are complex in nature. GAP (Glasgow Coma Scale, Age, Systolic blood pressure) and mGAP (mechanism, Glasgow Coma Scale, Age, Systolic blood pressure) scores are relatively simple scoring tools. However, these scores were not validated in low and middle income countries including Malaysia and its accuracies are influenced by the fluctuating physiologic parameters. This study aims to develop a relevant simplified anatomic trauma scoring system for the local trauma patients in Malaysia. METHOD: A total of 3825 trauma patients from 2011 to 2016 were extracted from the Hospital Sultanah Aminah Trauma Surgery Registry. Patients were split into a development sample (n = 2683) and a validation sample (n = 1142). Univariate analysis is applied to identify significant anatomic predictors. These predictors were further analyzed using multivariable logistic regression to develop the new score and compared to existing score systems. The quality of prediction was determined regarding discrimination using sensitivity, specificity and receiver operating characteristic [ROC] curve. RESULTS: Existing simplified score systems (GAP & mGAP) revealed areas under the ROC curve of 0.825 and 0.806. The newly developed HeCLLiP (Head, cervical spine, lung, liver, pelvic fracture) score combines only five anatomic components: injury involving head, cervical spine, lung, liver and pelvic bone. The probabilities of mortality can be estimated by charting the total score points onto a graph chart or using the cut-off value of (>2) with a sensitivity of 79.2 and specificity of 70.6% on the validation dataset. The HeCLLiP score achieved comparable values of 0.802 for the area under the ROC curve in validation samples. CONCLUSION: HeCLLiP Score is a simplified anatomic score suited to the local Malaysian population with a good predictive ability for trauma mortality.

摘要

背景:大多数创伤死亡率预测评分的性质都很复杂。GAP(格拉斯哥昏迷评分、年龄、收缩压)和 mGAP(机制、格拉斯哥昏迷评分、年龄、收缩压)评分是相对简单的评分工具。然而,这些评分在包括马来西亚在内的中低收入国家尚未得到验证,其准确性受到波动的生理参数的影响。本研究旨在为马来西亚当地创伤患者开发相关的简化解剖创伤评分系统。

方法:从 2011 年至 2016 年,从 Hospital Sultanah Aminah 创伤外科登记处提取了 3825 名创伤患者。将患者分为开发样本(n=2683)和验证样本(n=1142)。应用单变量分析确定显著的解剖预测因素。使用多变量逻辑回归对这些预测因素进行进一步分析,以开发新的评分并与现有评分系统进行比较。使用灵敏度、特异性和接收者操作特征 [ROC] 曲线来确定预测的质量。

结果:现有的简化评分系统(GAP 和 mGAP)显示 ROC 曲线下面积分别为 0.825 和 0.806。新开发的 HeCLLiP(头部、颈椎、肺、肝、骨盆骨折)评分仅结合了五个解剖成分:头部、颈椎、肺、肝和骨盆骨损伤。可以通过将总评分点绘制到图表上或使用验证数据集上的截断值(>2)来估计死亡率的概率,其灵敏度为 79.2%,特异性为 70.6%。HeCLLiP 评分在验证样本中的 ROC 曲线下面积的数值为 0.802。

结论:HeCLLiP 评分是一种简化的解剖评分,适用于马来西亚当地人群,对创伤死亡率具有良好的预测能力。

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