急诊科收治的严重创伤患者入院时死亡初始危险因素评估

Assessment of the Initial Risk Factors for Mortality among Patients with Severe Trauma on Admission to the Emergency Department.

作者信息

Park Hyun Oh, Choi Jun Young, Jang In Seok, Kim Jong Duk, Choi Jae Won, Lee Chung Eun

机构信息

Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea.

出版信息

Korean J Thorac Cardiovasc Surg. 2019 Dec;52(6):400-408. doi: 10.5090/kjtcs.2019.52.6.400. Epub 2019 Dec 5.

DOI:10.5090/kjtcs.2019.52.6.400

PMID:31832376

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6901184/

Abstract

BACKGROUND

For decades, trauma has been recognized globally as a major cause of death. Reducing the mortality of patients with trauma is an extremely pressing issue, particularly for those with severe trauma. An early and accurate assessment of the risk of mortality among patients with severe trauma is important for improving patient outcomes.

METHODS

We performed a retrospective medical record review of 582 patients with severe trauma admitted to the emergency department between July 2011 and June 2016. We analyzed the associations of in-hospital mortality with the baseline characteristics and initial biochemical markers of patients with severe trauma on admission.

RESULTS

The overall in-hospital mortality rate was 14.9%. Multivariate logistic regression analysis showed that the patient's Rapid Emergency Medicine Score (REMS; odds ratio [OR], 1.186; 95% confidence interval [CI], 1.018-1.383; p=0.029), Emergency Trauma Score (EMTRAS; OR, 2.168; 95% CI, 1.570-2.994; p<0.001), serum lactate levels (SLL; OR, 1.298; 95% CI, 1.118-1.507; p<0.001), and Injury Severity Score (ISS; OR, 1.038; 95% CI, 1.010-1.130; p=0.021) were significantly associated with in-hospital mortality.

CONCLUSION

The REMS, EMTRAS, and SLL can easily and rapidly be used as alternatives to the injury severity score to predict in-hospital mortality for patients who present to the emergency department with severe trauma.

摘要

背景

几十年来，创伤在全球范围内一直被公认为主要死因。降低创伤患者的死亡率是一个极其紧迫的问题，对于严重创伤患者而言尤为如此。早期准确评估严重创伤患者的死亡风险对于改善患者预后至关重要。

方法

我们对2011年7月至2016年6月期间急诊科收治的582例严重创伤患者进行了回顾性病历审查。我们分析了严重创伤患者入院时的基线特征和初始生化指标与院内死亡率之间的关联。

结果

总体院内死亡率为14.9%。多因素逻辑回归分析显示，患者的快速急诊医学评分（REMS；比值比[OR]，1.186；95%置信区间[CI]，1.018 - 1.383；p = 0.029）、急诊创伤评分（EMTRAS；OR，2.168；95% CI，1.570 - 2.994；p < 0.001）、血清乳酸水平（SLL；OR，1.298；95% CI，1.118 - 1.507；p < 0.001）和损伤严重程度评分（ISS；OR，1.038；95% CI，1.010 - 1.130；p = 0.021）与院内死亡率显著相关。