Becker Nils, Hammen Antonia, Bläsius Felix, Weber Christian David, Hildebrand Frank, Horst Klemens
Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH University Hospital Aachen, 52074 Aachen, Germany.
Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH University Hospital Aachen, 52074 Aachen, Germany.
J Clin Med. 2023 Aug 3;12(15):5111. doi: 10.3390/jcm12155111.
Patients that suffer from severe multiple trauma are highly vulnerable to the development of complications that influence their outcomes. Therefore, this study aimed to evaluate the risk factors that can facilitate an early recognition of adult patients at risk. The inclusion criteria were as follows: admission to a level 1 trauma center, injury severity score (ISS) ≥ 16 (severe injury was defined by an abbreviated injury score (AIS) ≥ 3) and ≥18 years of age. Injury- and patient-associated factors were correlated with the development of four complication clusters (surgery-related, infection, thromboembolic events and organ failure) and three mortality time points (immediate (6 h after admission), early (>6 h-72 h) and late (>72 h) mortality). Statistical analysis was performed using a Chi-square, Mann-Whitney U test, Cox hazard regression analysis and binominal logistic regression analysis. In total, 383 patients with a median ISS of 24 (interquartile range (IQR) 17-27) were included. The overall mortality rate (27.4%) peaked in the early mortality group. Lactate on admission significantly correlated with immediate and early mortality. Late mortality was significantly influenced by severe head injuries in patients with a moderate ISS (ISS 16-24). In patients with a high ISS (≥25), late mortality was influenced by a higher ISS, older age and higher rates of organ failure. Complications were observed in 47.5% of all patients, with infections being seen most often. The development of complications was significantly influenced by severe extremity injuries, the duration of mechanical ventilation and length of ICU stay. Infection remains the predominant posttraumatic complication. While immediate and early mortality is mainly influenced by the severity of the initial trauma, the rates of severe head injuries influence late mortality in moderate trauma severity, while organ failure remains a relevant factor in patients with a high injury severity.
遭受严重多发伤的患者极易发生影响其预后的并发症。因此，本研究旨在评估有助于早期识别高危成年患者的危险因素。纳入标准如下：入住一级创伤中心、损伤严重程度评分（ISS）≥16（严重损伤定义为简明损伤评分（AIS）≥3）且年龄≥18岁。将损伤及患者相关因素与四个并发症集群（手术相关、感染、血栓栓塞事件和器官衰竭）及三个死亡时间点（即刻（入院后6小时）、早期（>6小时至72小时）和晚期（>72小时）死亡）的发生情况进行关联分析。采用卡方检验、曼-惠特尼U检验、Cox风险回归分析和二项逻辑回归分析进行统计分析。共纳入383例患者，ISS中位数为24（四分位数间距（IQR）17 - 27）。总体死亡率（27.4%）在早期死亡组达到峰值。入院时的乳酸水平与即刻和早期死亡率显著相关。中度ISS（ISS 16 - 24）患者的晚期死亡率受严重颅脑损伤的显著影响。在高ISS（≥25）患者中，晚期死亡率受较高的ISS、年龄较大和器官衰竭发生率较高的影响。47.5%的患者出现并发症，其中感染最为常见。严重肢体损伤、机械通气时间和ICU住院时间对并发症的发生有显著影响。感染仍然是主要的创伤后并发症。虽然即刻和早期死亡率主要受初始创伤严重程度的影响，但严重颅脑损伤的发生率影响中度创伤严重程度患者的晚期死亡率，而器官衰竭在高损伤严重程度患者中仍然是一个相关因素。
