Division of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY.
Division of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY.
Surgery. 2020 May;167(5):821-828. doi: 10.1016/j.surg.2019.12.003. Epub 2020 Feb 14.
The Revised Trauma Score is the standard physiologic injury severity indicator used in trauma research and quality control. Shock index, peripheral oxygen saturation, and temperature have emerged as strong predictors for mortality and morbidity. We hypothesized that replacing systolic blood pressure and respiratory rate with age-adjusted shock index and peripheral oxygen saturation and adding temperature would generate a more accurate model, valid across all ages.
This is a retrospective database analysis using children and adults from the National Trauma Data Bank for years 2011 to 2015. Glasgow Coma Scale, systolic blood pressure, heart rate, respiratory rate, peripheral oxygen saturation, temperature, and shock index (calculated as heart rate/systolic blood pressure) were used as predictor variables, alone or in combination, in logistic models with survival as primary outcome. Bayesian information criterion and area under the receiver operator characteristic curve were used to compare models' performances. To adjust for age, models tested on the entire population (children and adults) used Z-scores derived on age-based homogenous intervals rather than the raw value.
The analysis included 283,724 pediatric and 1,555,478 adult patients. Overall mortality was 0.7% and 2.7%, respectively. The Glasgow Coma Scale + shock index + peripheral oxygen saturation + temperature model outperformed the revised trauma score in both adults (Bayesian information criterion 296,345.94 vs 298,494.72; area under the receiver operator characteristic curve 0.831 vs 0.809, P < .001) and children (Bayesian information criterion 12,251.48 vs 12,283.48; area under the receiver operator characteristic curve 0.974 vs 0.968, P = .05) cohorts. On the merged (children and adults) cohort the Glasgow Coma Scale + Z-scores derived on age-based homogenous intervals + peripheral oxygen saturation + temperature model outperformed the Revised Trauma Score (Bayesian information criterion 313,814.78 vs 317,781.31; area under the receiver operator characteristic curve 0.852 vs 0.809, P < .001).
Replacing systolic blood pressure and respiratory rate with shock index and peripheral oxygen saturation in the Revised Trauma Score model and adding temperature generated a more accurate model in both children and adults. Adjusting shock index for age rendered the model accurate across all ages. Calibration on population-derived nomograms of vital signs would further increase the model's accuracy and precision.
修订后的创伤评分是创伤研究和质量控制中使用的标准生理损伤严重程度指标。休克指数、外周血氧饱和度和体温已成为死亡率和发病率的强有力预测因素。我们假设用年龄校正的休克指数和外周血氧饱和度代替收缩压和呼吸率，并加入体温，将生成一个更准确的模型，适用于所有年龄段。
这是一项回顾性数据库分析，使用了 2011 年至 2015 年国家创伤数据库中的儿童和成人数据。格拉斯哥昏迷评分、收缩压、心率、呼吸率、外周血氧饱和度、体温和休克指数（计算为心率/收缩压）被用作预测变量，单独或组合使用，与生存作为主要结局的逻辑模型。贝叶斯信息准则和接收者操作特征曲线下面积用于比较模型的性能。为了调整年龄，在整个人群（儿童和成人）上测试的模型使用基于年龄的同质区间的 Z 分数，而不是原始值。
该分析包括 283724 名儿科患者和 1555478 名成年患者。总体死亡率分别为 0.7%和 2.7%。格拉斯哥昏迷评分+休克指数+外周血氧饱和度+体温模型在成人（贝叶斯信息准则 296345.94 与 298494.72；接收者操作特征曲线下面积 0.831 与 0.809，P<.001）和儿童（贝叶斯信息准则 12251.48 与 12283.48；接收者操作特征曲线下面积 0.974 与 0.968，P=0.05）两组中均优于修订后的创伤评分。在合并（儿童和成人）队列中，格拉斯哥昏迷评分+基于年龄的同质区间的 Z 分数+外周血氧饱和度+体温模型优于修订后的创伤评分（贝叶斯信息准则 313814.78 与 317781.31；接收者操作特征曲线下面积 0.852 与 0.809，P<.001）。
在修订后的创伤评分模型中用休克指数和外周血氧饱和度代替收缩压和呼吸率，并加入体温，生成了一个在儿童和成人中更准确的模型。用年龄校正休克指数使模型在所有年龄段都具有准确性。对源自人群的生命体征预测图的校准将进一步提高模型的准确性和精度。
