From the, Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, OR, USA.
the, Pacific Northwest Evidence-based Practice Center, Portland, OR, USA.
Acad Emerg Med. 2020 Dec;27(12):1323-1339. doi: 10.1111/acem.14056. Epub 2020 Jul 20.
The objective was to systematically identify and summarize out-of-hospital measures of circulatory compromise as diagnostic predictors of serious injury, focusing on measures usable by emergency medical services to inform field triage decisions.
We searched Ovid MEDLINE, CINAHL, and the Cochrane databases from 1996 through August 2017 for published literature on individual circulatory measures in trauma. We reviewed reference lists of included articles for additional relevant citations. Measures of diagnostic accuracy included sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). Indicators of serious injury included resource need, serious anatomic injury, and mortality. We pooled estimates when data permitted.
We identified 114 articles, reporting results of 111 studies. Measures included systolic blood pressure (sBP), heart rate (HR), shock index (SI), lactate, base deficit, and HR variability. Pooled out-of-hospital sensitivity estimates were sBP < 90 mm Hg = 19% (95% confidence interval [CI] = 12% to 29%), HR ≥ 110 beats/min = 28% (95% CI = 20% to 37%), SI > 0.9 = 37% (95% CI = 22% to 56%), and lactate > 2.0 mmol/L = 74% (95% CI = 48% to 90%). Pooled specificity estimates were sBP < 90 mm Hg = 95% (95% CI = 91% to 97%), HR ≥ 110 beats/min = 85% (95% CI = 74% to 91%), SI > 0.9 = 85% (95% CI = 72% to 92%), and lactate > 2.0 mmol/L = 62% (95% CI = 51% to 72%). Pooled AUROCs included sBP = 0.67 (95% CI = 0.58 to 0.75), HR = 0.67 (95% CI = 0.56 to 0.79), SI = 0.72 (95% CI = 0.66 to 0.77), and lactate = 0.77 (95% CI = 0.67 to 0.82). Strength of evidence was low to moderate.
Out-of-hospital circulatory measures are associated with poor to fair discrimination for identifying trauma patients with serious injuries. Many seriously injured patients have normal circulatory measures (low sensitivity), but when present, the measures are highly specific for identifying patients with serious injuries.
本研究旨在系统地识别和总结院外循环功能障碍的评估方法，将其作为严重损伤的诊断预测指标，重点关注可被急救医疗服务人员用于指导现场分诊决策的评估方法。
我们检索了 Ovid MEDLINE、CINAHL 和 Cochrane 数据库，获取了 1996 年至 2017 年 8 月期间发表的关于创伤中个体循环评估方法的文献。我们还查阅了纳入文章的参考文献列表，以获取其他相关文献。诊断准确性的评估指标包括敏感性、特异性和受试者工作特征曲线下面积（AUROC）。严重损伤的指标包括资源需求、严重解剖学损伤和死亡率。当数据允许时，我们进行了汇总估计。
我们共识别出 114 篇文章，其中报道了 111 项研究的结果。评估方法包括收缩压（sBP）、心率（HR）、休克指数（SI）、乳酸、碱缺失和心率变异性。院外敏感性的汇总估计值为 sBP<90mmHg 为 19%（95%CI=12%至 29%），HR≥110 次/分钟为 28%（95%CI=20%至 37%），SI>0.9 为 37%（95%CI=22%至 56%），乳酸>2.0mmol/L 为 74%（95%CI=48%至 90%）。特异性的汇总估计值为 sBP<90mmHg 为 95%（95%CI=91%至 97%），HR≥110 次/分钟为 85%（95%CI=74%至 91%），SI>0.9 为 85%（95%CI=72%至 92%），乳酸>2.0mmol/L 为 62%（95%CI=51%至 72%）。AUROC 的汇总估计值包括 sBP=0.67（95%CI=0.58 至 0.75），HR=0.67（95%CI=0.56 至 0.79），SI=0.72（95%CI=0.66 至 0.77），乳酸=0.77（95%CI=0.67 至 0.82）。证据强度为低至中度。
院外循环功能障碍评估方法与识别严重创伤患者的不良至中等程度的区分能力相关。许多严重受伤的患者循环功能评估正常（敏感性低），但当存在时，这些评估方法对识别严重受伤患者具有高度特异性。
