Habibpour Hamidreza, Torabi Mehdi, Mirzaee Moghaddameh
Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran.
Department of Biostatistics and Epidemiology, School of Public Health, University of Medical Sciences, Kerman, Iran.
Bull Emerg Trauma. 2019 Jan;7(1):55-59. doi: 10.29252/beat-070108.
To investigate the role of red cell distribution width (RDW) in comparison with Trauma-Associated Severe Hemorrhage (TASH) system in predicting the mortality of multiple trauma patients, referred to the hospital emergency department.
This follow-up study was conducted on multiple trauma patients (age ≥ 18 years) with Injury Severity Scores (ISS) of ≥ 16, who were referred to the emergency department from March 1, 2017, to December 1, 2017. First, all patients were evaluated based on the Advanced Trauma Life Support (ATLS) guidelines, and then, their blood samples were sent for RDW measurements at baseline and 24 hours after admission. The ISS, Revised Trauma Score (RTS), and TASH were measured in the follow-ups and recorded by third-year emergency medicine residents. Hospital mortality was considered as the outcome of the study.
In this study, 200 out of 535 multiple trauma patients were recruited. The frequency of hospital mortality was 19 (9.5%). In the univariate analysis, there was no significant relationship between hospital mortality and RDW at baseline, RDW on the first day, and ΔRDW (RDW at baseline - RDW on the first day), unlike ISS, RTS, TASH (=0.97, = 0.28, and =0.24, respectively). On the other hand, in the multivariate analysis, ISS, RTS, and TASH showed a significant relationship with hospital mortality. The greatest area under the ROC curve (AUC) was attributed to TASH and RTS systems (0.94 and 0.93, respectively).
TASH scoring system, which was mainly designed to predict the need for massive transfusion, may be of prognostic value for hospital mortality in multiple trauma patients, similar to ISS and RTS scoring systems.
探讨红细胞分布宽度（RDW）与创伤相关严重出血（TASH）系统相比，在预测转诊至医院急诊科的多发伤患者死亡率方面的作用。
本随访研究针对2017年3月1日至2017年12月1日转诊至急诊科、年龄≥18岁且损伤严重程度评分（ISS）≥16的多发伤患者进行。首先，所有患者均按照高级创伤生命支持（ATLS）指南进行评估，然后采集其血液样本，在基线及入院后24小时进行RDW测量。随访时测量ISS、修订创伤评分（RTS）和TASH，并由三年级急诊医学住院医师记录。将医院死亡率视为研究结果。
本研究纳入了535例多发伤患者中的200例。医院死亡率为19例（9.5%）。在单因素分析中，与ISS、RTS、TASH不同（分别为=0.97、=0.28和=0.24），基线时的RDW、第一天的RDW以及ΔRDW（基线时的RDW - 第一天的RDW）与医院死亡率之间无显著关系。另一方面，在多因素分析中，ISS、RTS和TASH与医院死亡率显示出显著关系。最大的受试者工作特征曲线下面积（AUC）归因于TASH和RTS系统（分别为0.94和0.93）。
主要用于预测大量输血需求的TASH评分系统，可能与ISS和RTS评分系统一样，对多发伤患者的医院死亡率具有预后价值。
