Walker Patrick F, Schobel Seth, Caruso Joseph D, Rodriguez Carlos J, Bradley Matthew J, Elster Eric A, Oh John S
Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Surgery, Landstuhl Regional Medical Center, Landstuhl, Germany.
Trauma Surg Acute Care Open. 2019 Dec 15;4(1):e000367. doi: 10.1136/tsaco-2019-000367. eCollection 2019.
Clinical decision support tools capable of predicting which patients are at highest risk for venous thromboembolism (VTE) can assist in guiding surveillance and prophylaxis decisions. The Trauma Embolic Scoring System (TESS) has been shown to model VTE risk in civilian trauma patients. No such support tools have yet been described in combat casualties, who have a high incidence of VTE. The purpose of this study was to evaluate the utility of TESS in predicting VTE in military trauma patients.
A retrospective cohort study of 549 combat casualties from October 2010 to November 2012 admitted to a military treatment facility in the USA was performed. TESS scores were calculated through data obtained from the Department of Defense Trauma Registry and chart reviews. Univariate analysis and multivariate logistic regression were performed to evaluate risk factors for VTE. Receiver operating characteristic (ROC) curve analysis of TESS in military trauma patients was also performed.
The incidence of VTE was 21.7% (119/549). The median TESS for patients without VTE was 8 (IQR 4-9), and the median TESS for those with VTE was 10 (IQR 9-11). On multivariate analysis, Injury Severity Score (ISS) (OR 1.03, p=0.007), ventilator days (OR 1.05, p=0.02), and administration of tranexamic acid (TXA) (OR 1.89, p=0.03) were found to be independent risk factors for development of VTE. On ROC analysis, an optimal high-risk cut-off value for TESS was ≥7 with a sensitivity of 0.92 and a specificity of 0.53 (area under the curve 0.76, 95% CI 0.72 to 0.80, p<0.0001).
When used to predict VTE in military trauma, TESS shows moderate discrimination and is well calibrated. An optimal high-risk cut-off value of ≥7 demonstrates high sensitivity in predicting VTE. In addition to ISS and ventilator days, TXA administration is an independent risk factor for VTE development.
Level III.
能够预测哪些患者发生静脉血栓栓塞症（VTE）风险最高的临床决策支持工具，有助于指导监测和预防决策。创伤栓塞评分系统（TESS）已被证明可用于模拟 civilian 创伤患者的VTE风险。在VTE发生率较高的战斗伤员中，尚未有此类支持工具的相关描述。本研究的目的是评估TESS在预测军事创伤患者VTE方面的效用。
对2010年10月至2012年11月入住美国一家军事治疗机构的549名战斗伤员进行了一项回顾性队列研究。通过从国防部创伤登记处获取的数据和病历审查计算TESS评分。进行单因素分析和多因素逻辑回归以评估VTE的危险因素。还对军事创伤患者的TESS进行了受试者操作特征（ROC）曲线分析。
VTE的发生率为21.7%（119/549）。无VTE患者的TESS中位数为8（四分位间距4 - 9），有VTE患者的TESS中位数为10（四分位间距9 - 11）。多因素分析显示，损伤严重程度评分（ISS）（比值比1.03，p = 0.007）、机械通气天数（比值比1.05，p = 0.02）和氨甲环酸（TXA）的使用（比值比1.89，p = 0.03）是发生VTE的独立危险因素。ROC分析显示，TESS的最佳高风险临界值为≥7，灵敏度为0.92，特异度为0.53（曲线下面积0.76，95%置信区间0.72至0.80，p < 0.0001）。
当用于预测军事创伤患者的VTE时，TESS显示出中等的区分能力且校准良好。最佳高风险临界值≥7在预测VTE方面具有高灵敏度。除了ISS和机械通气天数外，TXA的使用是VTE发生的独立危险因素。
三级。
