Zhuang Yangfan, Tu Hao, Feng Quanrui, Tang Huiming, Fu Li, Wang Yuchang, Bai Xiangjun
Trauma Center/Department of Emergency and Traumatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
Department of Intensive Care Unit, First Hospital of Wuhan, Wuhan, Hubei Province, People's Republic of China.
Int J Gen Med. 2022 Jun 7;15:5499-5512. doi: 10.2147/IJGM.S365635. eCollection 2022.
Currently, assessing trauma severity alone in geriatric trauma patients (GTPs) cannot accurately predict the risk of serious adverse outcomes during hospitalization. As an emerging concept in recent years, frailty syndrome is closely related to the poor prognosis of many diseases in elderly patients, including trauma. A logistic model for predicting adverse outcomes in elderly trauma patients during hospitalization was constructed in elderly patients, and the predictive efficacy of the model was verified.
Trauma patients aged ≥65 years between June 2020 and September 2021 were selected and randomly divided into a training set and validation set at a ratio of 3:1. Mid arm muscle circumference (MAMC) was measured to determine the degree of frailty. LASSO regression was used to screen appropriate variables for the construction of a prognostic model. The logistic regression model was established and presented in the form of a nomogram. Calibration curves and ROC curves were used to verify the performance of the model.
A total of 209 patients were enrolled, including 143 (68.4%) males and 66 (31.6%) females, with an average age of 70.8 ± 4.8 years. Ageless Charlson comorbidity index, BT unit, ISS, GCS, MAMC, prealbumin and lactic acid levels were screened by LASSO regression to construct a prognostic model. The AUC of the ROC analysis prediction model was 0.89 (95% CI 0.80-0.97) in the validation set. The results of the Hosmer-Lemeshow test for the validation set were χ2 = 11.23, P = 0.189.
The prognostic model of adverse outcomes in GTPs has good accuracy and differentiation, which can improve the prediction results of risk stratification of GTPs during hospitalization by medical staff and provide a new idea for prognostic prediction.
目前，仅评估老年创伤患者（GTPs）的创伤严重程度并不能准确预测其住院期间严重不良结局的风险。作为近年来出现的一个概念，衰弱综合征与老年患者多种疾病（包括创伤）的不良预后密切相关。本研究在老年患者中构建了预测老年创伤患者住院期间不良结局的逻辑模型，并验证了该模型的预测效能。
选取2020年6月至2021年9月期间年龄≥65岁的创伤患者，按3:1的比例随机分为训练集和验证集。测量上臂中部肌肉周长（MAMC）以确定衰弱程度。采用LASSO回归筛选合适变量以构建预后模型。建立逻辑回归模型并以列线图的形式呈现。使用校准曲线和ROC曲线验证模型的性能。
共纳入209例患者，其中男性143例（6８.4%），女性66例（31.6%），平均年龄70.8±4.8岁。通过LASSO回归筛选出无年龄校正的Charlson合并症指数、BT单位、ISS、GCS、MAMC、前白蛋白和乳酸水平，构建预后模型。验证集中ROC分析预测模型的AUC为0.89（95%CI 0.80 - 0.97）。验证集的Hosmer-Lemeshow检验结果为χ2 = 11.23，P = 0.189。
GTPs不良结局的预后模型具有良好的准确性和区分度，可提高医护人员对GTPs住院期间风险分层的预测结果，为预后预测提供新思路。
