Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, California.
Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, California.
J Surg Res. 2020 Mar;247:227-233. doi: 10.1016/j.jss.2019.09.071. Epub 2019 Nov 20.
Little is known about the injuries, mechanisms, and outcomes in trauma patients undergoing sternotomy for hemorrhage control (SHC). The purpose of this study was to identify predictors of mortality for SHC and provide a descriptive analysis of the use of SHC in trauma. We hypothesize blunt trauma is associated with higher mortality compared with penetrating trauma among trauma patients requiring SHC.
The Trauma Quality Improvement Program (2013-2016) database was queried for adult patients undergoing SHC within 24 h of admission. Patients with blunt and penetrating trauma were compared using chi-square and Mann-Whitney U-test. A multivariable logistic regression model was used to determine the risk of mortality.
Of 584 patients undergoing SHC, 322 (55.1%) were involved in penetrating trauma, and 69 (11.8%) were involved in blunt. The blunt trauma group had a higher median injury severity score (31.5 versus 25.0; P < 0.001) compared with the penetrating group. The median time to hemorrhage control was longer in those with blunt compared with penetrating trauma (84.6 versus 49.8 min; P < 0.001). The mortality rate was higher in patients with blunt compared with penetrating trauma (29.0% versus 12.7%; P < 0.001). However, after adjusting for covariates, there was no difference in risk of mortality between blunt and penetrating trauma (P = 0.06).
Trauma patients requiring SHC after blunt trauma had a higher mortality rate than those in penetrating trauma. After adjusting for predictors of mortality, there was no difference in risk of mortality despite nearly double the time to hemorrhage control in patients presenting after blunt trauma.
对于因控制出血而行胸骨切开术（SHC）的创伤患者，其损伤、机制和结局知之甚少。本研究旨在确定需要 SHC 的创伤患者死亡的预测因素，并对 SHC 在创伤中的应用进行描述性分析。我们假设与穿透性创伤相比，钝性创伤患者在需要 SHC 的患者中死亡率更高。
在创伤质量改进计划（2013-2016 年）数据库中，对 24 小时内接受 SHC 的成年患者进行了查询。使用卡方检验和 Mann-Whitney U 检验比较了钝性和穿透性创伤患者。使用多变量逻辑回归模型确定死亡率的风险。
在 584 例接受 SHC 的患者中，322 例（55.1%）为穿透性创伤，69 例（11.8%）为钝性创伤。与穿透性组相比，钝性组的损伤严重程度评分中位数更高（31.5 与 25.0；P < 0.001）。与穿透性创伤相比，钝性创伤患者达到出血控制的中位数时间更长（84.6 与 49.8 分钟；P < 0.001）。与穿透性创伤相比，钝性创伤患者的死亡率更高（29.0%与 12.7%；P < 0.001）。但是，在调整了混杂因素后，钝性和穿透性创伤之间的死亡率风险没有差异（P = 0.06）。
因钝性创伤而行 SHC 的创伤患者的死亡率高于穿透性创伤患者。尽管钝性创伤患者达到出血控制的时间几乎延长了一倍，但在调整了死亡率的预测因素后，死亡率风险没有差异。
