Udagawa Kazuhiko, Yamamoto Ryo, Shimatani Naotaka, Nishida Yusho, Ono Soichiro, Niki Yasuo, Sasaki Junichi
Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan; Department of Orthopedic Surgery, Keio University School of Medicine, Japan.
Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
Injury. 2024 Jun;55(6):111117. doi: 10.1016/j.injury.2023.111117. Epub 2023 Oct 12.
Early appropriate care (EAC) is widely accepted as a safe strategy to perform early definitive fracture fixation, and good clinical outcomes have been reported in selected, multiply injured patients, although the optimal candidate for early definitive fixation (EDF) has not been validated. The aim of this study was to identify simple clinical parameters to help select patients who could undergo EDF.
Patients with extremity injuries who underwent open reduction and internal fixation were retrospectively identified, using data from the Japan Trauma Data Bank (JTDB). Age, vital signs on hospital presentation, and the injury severity score (ISS) were examined by transforming these variables to binary categories. Patients were divided into categories based on these variables, and in-hospital mortality was compared between patients treated with EDF (EDF group) and those treated without EDF (non-EDF group) in each category.
Of the 12,735 patients who were eligible for the analyses, 3706 (29.1 %) were managed with EDF. In-hospital mortality was significantly higher in the EDF group than in the non-EDF group among patients with a low Glasgow Coma Scale (GCS) score (<13), low systolic blood pressure (sBP) (<90 mmHg), and ISS≥15, whereas in-hospital mortality was comparable between the EDF and non-EDF groups among patients with GCS scores ≥13, sBP ≥90 mmHg, and ISS <15.
In this large nationwide database of trauma patients, EDF was performed without affecting mortality in patients with GCS scores ≥13 and sBP ≥90 mmHg on hospital presentation, as well as ISS <15. These parameters might be useful as screening tools to select the candidates who could be treated with EDF safely.
早期适当治疗（EAC）作为一种进行早期确定性骨折固定的安全策略已被广泛接受，并且在部分多发伤患者中已报道有良好的临床结果，尽管早期确定性固定（EDF）的最佳适用患者尚未得到验证。本研究的目的是确定简单的临床参数，以帮助选择能够接受EDF的患者。
利用日本创伤数据库（JTDB）的数据，对接受切开复位内固定的肢体损伤患者进行回顾性分析。通过将年龄、入院时生命体征和损伤严重程度评分（ISS）这些变量转换为二元类别来进行研究。根据这些变量将患者分类，并比较每类中接受EDF治疗的患者（EDF组）和未接受EDF治疗的患者（非EDF组）的院内死亡率。
在12735例符合分析条件的患者中，3706例（29.1%）接受了EDF治疗。在格拉斯哥昏迷量表（GCS）评分低（<13）、收缩压（sBP）低（<90 mmHg）且ISS≥15的患者中，EDF组的院内死亡率显著高于非EDF组；而在GCS评分≥13、sBP≥90 mmHg且ISS<15的患者中，EDF组和非EDF组的院内死亡率相当。
在这个全国性的大型创伤患者数据库中，对于入院时GCS评分≥13、sBP≥90 mmHg且ISS<15的患者，进行EDF治疗不会影响其死亡率。这些参数可能作为筛选工具，用于安全地选择能够接受EDF治疗的患者。
