Yamamoto Ryo, Udagawa Kazuhiko
Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
J Orthop Sci. 2023 Jan;28(1):255-260. doi: 10.1016/j.jos.2021.10.002. Epub 2021 Oct 30.
While various strategies of fracture fixation for trauma patients have been discussed, optimal candidates remain unclear for early definitive fixation. The aim of this study was to integrate several clinical parameters into a scoring system and determine a cut-off value for safe early definitive surgery for extremity fractures.
We retrospectively identified patients with fracture in an extremity in Japanese Trauma Data Bank from 2004 to 2019. We included adult patients who underwent open reduction and internal fixation for extremity injury before any other surgical intervention and excluded those who arrived with cardiac arrest. Several clinical parameters, such as age, vital signs, abbreviated injury scale (AIS) in the chest, and injury severity score (ISS), were examined with multivariate logistic regression models to predict in-hospital mortality, and then integrated into a scoring system based on each odds ratio. To determine a cut-off value of the scoring system for safe early definitive surgery, in-hospital mortality and/or postoperative complications were compared between patients who underwent definitive fixation within 24 h of injury and patients who did not in subgroups based on the scores.
Of 50,631 patients eligible for this study, 16,119 (31.8%) underwent early definitive fixation. A 0-15 scoring system with parameters including age >70 years, GCS <8, systolic blood pressure <90 mmHg, AIS in the chest ≥3, ISS ≥20, and transfusion requirement within 24 h of arrival was developed. At scores ≥10, early definitive fixation was found to be significantly associated with high in-hospital mortality, and at scores <10, in-hospital mortality was comparable between the two groups.
We integrated clinical parameters into the scoring system with a scale of 0-15 and determined that a score of 10 is the cut-off score. We determined that patients with a score <10 can safely undergo early definitive fixation.
虽然已经讨论了创伤患者骨折固定的各种策略，但早期确定性固定的最佳人选仍不明确。本研究的目的是将几个临床参数整合到一个评分系统中，并确定四肢骨折安全早期确定性手术的临界值。
我们回顾性地在日本创伤数据库中识别出2004年至2019年期间四肢骨折的患者。我们纳入了在任何其他手术干预之前接受了四肢损伤切开复位内固定术的成年患者，并排除了入院时心脏骤停的患者。使用多因素逻辑回归模型检查了几个临床参数，如年龄、生命体征、胸部简明损伤量表（AIS）和损伤严重程度评分（ISS），以预测住院死亡率，然后根据每个比值比将其整合到一个评分系统中。为了确定安全早期确定性手术评分系统的临界值，根据评分在亚组中比较了受伤后24小时内接受确定性固定的患者和未接受确定性固定的患者的住院死亡率和/或术后并发症。
在50631名符合本研究条件的患者中，16119名（31.8%）接受了早期确定性固定。开发了一个0至15分的评分系统，其参数包括年龄>70岁、格拉斯哥昏迷量表（GCS）<8、收缩压<90 mmHg、胸部AIS≥3、ISS≥20以及入院后24小时内需要输血。在评分≥10分时，发现早期确定性固定与高住院死亡率显著相关，而在评分< 10分时，两组之间的住院死亡率相当。
我们将临床参数整合到一个0至15分的评分系统中，并确定10分为临界分。我们确定评分<10分的患者可以安全地接受早期确定性固定。
