Banerjee Niladri, Bagaria Dinesh, Agarwal Harshit, Kumar Katiyar Anand, Kumar Subodh, Sagar Sushma, Mishra Biplab, Gupta Amit
Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, India.
Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Turk J Surg. 2022 Dec 20;38(4):391-400. doi: 10.47717/turkjsurg.2022.5793. eCollection 2022 Dec.
Complications during trauma management are the main factor responsible for the overall increase in treatment cost. There are very few grading systems to measure the burden of complications in trauma patients. A prospective study was conducted using the Adapted Clavien Dindo in Trauma (ACDiT) scale, with the primary aim of validating it at our center. As a secondary aim, it was also wanted to measure the mortality burden among our admitted patients.
The study was conducted at a dedicated trauma center. All patients with acute injuries, who were admitted, were included. An initial treatment plan was made within 24 hours of admission. Any deviation from this was recorded and graded according to the ACDiT. The grading was correlated with hospital-free days and ICU-free days within 30 days.
A total of 505 patients were included in this study, with a mean age of 31 years. The most common mechanism of injury was road traffic injury, with a median ISS and NISS of 13 and 14, respectively. Two hundred and forty-eight out of 505 patients had some grade of complication as determined by the ACDiT scale. Hospital-free days (13.5 vs. 25; p <0.001) were significantly lower in patients with complications than those without complications, and so were ICU-free days (29 vs. 30; p <0.001). Significant differences were also observed when comparing mean hospital free and ICU free days across various ACDiT grades. Overall mortality of the population was 8.3 %, the majority of whom were hypotensive on arrival and required ICU care.
We successfully validated the ACDiT scale at our center. We recommend using this scale to objectively measure in-hospital complications and improve trauma management quality. ACDiT scale should be one of the data points in any trauma database/registry.
创伤治疗过程中的并发症是治疗成本总体增加的主要因素。衡量创伤患者并发症负担的分级系统非常少。本研究采用创伤改良版Clavien-Dindo（ACDiT）量表进行前瞻性研究，主要目的是在我们中心验证该量表。作为次要目的，还希望测量我们收治患者的死亡负担。
本研究在一家专门的创伤中心进行。纳入所有收治的急性损伤患者。入院后24小时内制定初始治疗计划。任何与该计划的偏差均进行记录，并根据ACDiT进行分级。分级与30天内的非住院天数和非ICU天数相关。
本研究共纳入505例患者，平均年龄31岁。最常见的损伤机制是道路交通伤，损伤严重程度评分（ISS）和新损伤严重程度评分（NISS）中位数分别为13和14。根据ACDiT量表，505例患者中有248例出现某种程度的并发症。有并发症的患者非住院天数（13.5天对25天；p<0.001）显著低于无并发症的患者，非ICU天数（29天对30天；p<0.001）也是如此。比较不同ACDiT分级的平均非住院天数和非ICU天数时也观察到显著差异。总体人群死亡率为8.3%，其中大多数患者入院时血压低，需要ICU护理。
我们在中心成功验证了ACDiT量表。我们建议使用该量表客观测量院内并发症并提高创伤治疗质量。ACDiT量表应成为任何创伤数据库/登记处的数据点之一。
