Hälsan & Arbetslivet, Occupational Health Care Unit, Region Västra Götaland, Alingsås, Sweden.
Department of Public Health and Community Medicine Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
PLoS One. 2019 May 14;14(5):e0216694. doi: 10.1371/journal.pone.0216694. eCollection 2019.
Our aim was to develop a risk stratification model to predict the presence of a potentially more sinister injury in patients exposed to a whiplash trauma.
The study base comprised of 3,115 residents who first sought healthcare contact within one week after being exposed to a whiplash trauma between 1999-2008, from within a defined geographical area, Skaraborg County in south-western Sweden. Information about gender, age, time elapsed prior to seeking care, type of health care contact, and hospitalisation was retrieved. Seventeen potential risk factors were identified and evaluated using multivariable logistic regression.
Of 3,115 patients, 215 (6.9%) required hospital admission so theoretically 93% could have been initially assessed by primary health care. However, only 46% had their first contact in primary health care. All patients had symptoms resulting in a diagnosis of whiplash injury. Four risk factors were found to be associated with hospital admission: commotio cerebri (OR 31, 19-51), fracture / luxation (OR 11, 5.1-22), serious injury (OR 41, 8.0-210), and the patient sought care during the same day as the trauma (OR 5.9, 3.7-9.5). These four risk factors explained 27% of the variation for hospital admission and the area under curve (AUC) was 0.77 (0.74-0.80). Ninety-six percent of patients (2,985) had only a whiplash injury with no other injury. These could be split into those attending health care the same day as the trauma, 1,737 (56%) with a 7.1% risk for hospital admission, and those attending health care later, 1,248 (40%) with a 1.3% risk for hospital admission.
Patients with no signs of commotio cerebri, no fracture/luxation injury, no serious injury, comprising 96% of all patients exposed to a whiplash trauma can initially be referred to primary health care for initial assessment. However, those contacting the health care the same day as the trauma should be referred to a hospital for evaluation if they can't get an appointment with a general practitioner the same day.
我们旨在开发一种风险分层模型，以预测在遭受挥鞭样损伤的患者中存在潜在更严重损伤的可能性。
研究基础包括 1999-2008 年间在瑞典西南部斯科讷省的一个特定地理区域内首次寻求医疗接触的 3115 名居民。检索了有关性别、年龄、寻求医疗前的时间间隔、医疗接触类型和住院的信息。确定并使用多变量逻辑回归评估了 17 个潜在的危险因素。
在 3115 名患者中，215 名（6.9%）需要住院治疗，因此理论上 93%的患者可以在最初由初级保健评估。然而，只有 46%的患者在初级保健中进行了首次接触。所有患者均有导致挥鞭样损伤诊断的症状。发现 4 个危险因素与住院治疗有关：脑震荡（OR 31，19-51）、骨折/脱位（OR 11，5.1-22）、严重损伤（OR 41，8.0-210）以及患者在创伤发生当天寻求治疗（OR 5.9，3.7-9.5）。这四个危险因素解释了住院治疗的 27%的变化，曲线下面积（AUC）为 0.77（0.74-0.80）。96%（2985 名）的患者仅患有挥鞭样损伤而无其他损伤。这些患者可以分为在创伤发生当天就诊的患者（1737 名，占 56%），其中有 7.1%的住院治疗风险，以及在稍后就诊的患者（1248 名，占 40%），其中有 1.3%的住院治疗风险。
在所有遭受挥鞭样损伤的患者中，没有脑震荡、骨折/脱位损伤、严重损伤的迹象的患者占 96%，可以最初被转诊到初级保健进行初步评估。然而，如果他们无法在同一天预约全科医生，当天就诊的患者应被转介到医院进行评估。
