Department of Anesthesiology, Emergency and Intensive Care Medicine, Bergmannstrost Hospital Halle, Halle, Germany.
Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
PLoS One. 2021 Feb 10;16(2):e0246127. doi: 10.1371/journal.pone.0246127. eCollection 2021.
The evidence supporting the use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in severely injured patients is still debatable. Using the ABOTrauma Registry, we aimed to define factors affecting mortality in trauma REBOA patients. Data from the ABOTrauma Registry collected between 2014 and 2020 from 22 centers in 13 countries globally were analysed. Of 189 patients, 93 died (49%) and 96 survived (51%). The demographic, clinical, REBOA criteria, and laboratory variables of these two groups were compared using non-parametric methods. Significant factors were then entered into a backward logistic regression model. The univariate analysis showed numerous significant factors that predicted death including mechanism of injury, ongoing cardiopulmonary resuscitation, GCS, dilated pupils, systolic blood pressure, SPO2, ISS, serum lactate level and Revised Injury Severity Classification (RISCII). RISCII was the only significant factor in the backward logistic regression model (p < 0.0001). The odds of survival increased by 4% for each increase of 1% in the RISCII. The best RISCII that predicted 30-day survival in the REBOA treated patients was 53.7%, having a sensitivity of 82.3%, specificity of 64.5%, positive predictive value of 70.5%, negative predictive value of 77.9%, and usefulness index of 0.385. Although there are multiple significant factors shown in the univariate analysis, the only factor that predicted 30-day mortality in REBOA trauma patients in a logistic regression model was RISCII. Our results clearly demonstrate that single variables may not do well in predicting mortality in severe trauma patients and that a complex score such as the RISC II is needed. Although a complex score may be useful for benchmarking, its clinical utility can be hindered by its complexity.
支持严重创伤患者使用主动脉腔内球囊阻断复苏（REBOA）的证据仍存在争议。我们利用 ABOTrauma 登记处，旨在确定影响创伤性 REBOA 患者死亡率的因素。该研究分析了 2014 年至 2020 年期间来自全球 13 个国家 22 个中心的 ABOTrauma 登记处的数据。189 名患者中，93 人死亡（49%），96 人存活（51%）。使用非参数方法比较了这两组患者的人口统计学、临床、REBOA 标准和实验室变量。然后将有意义的因素纳入向后逻辑回归模型。单变量分析显示了许多预测死亡的显著因素，包括损伤机制、持续心肺复苏、GCS、瞳孔扩大、收缩压、SPO2、ISS、血清乳酸水平和修订损伤严重程度分类（RISCII）。RISCII 是向后逻辑回归模型中唯一有意义的因素（p < 0.0001）。RISCII 每增加 1%，存活的几率就会增加 4%。在接受 REBOA 治疗的患者中，预测 30 天存活率的最佳 RISCII 为 53.7%，其敏感性为 82.3%，特异性为 64.5%，阳性预测值为 70.5%，阴性预测值为 77.9%，有用指数为 0.385。尽管单变量分析显示存在多个显著因素，但在逻辑回归模型中，唯一能预测 REBOA 创伤患者 30 天死亡率的因素是 RISCII。我们的结果清楚地表明，单一变量可能无法很好地预测严重创伤患者的死亡率，需要使用复杂的评分，如 RISC II。虽然复杂的评分可能对基准测试有用，但由于其复杂性，其临床实用性可能会受到阻碍。
