Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Chin J Traumatol. 2024 Dec;27(6):389-394. doi: 10.1016/j.cjtee.2023.05.007. Epub 2023 Oct 27.
Upper extremity injuries (UEIs) and lower extremity injuries (LEIs) constitute a considerable component of traumas. However, their epidemiologic differences and short-term in-hospital outcomes are not fully elucidated. This study aims to compare such discrepancies in a large-scale study.
In this retrospective study, all patients with UEIs and/or LEIs hospitalized from 24th July 2016 to 16th May 2020 in Sina Hospital, Tehran, Iran, and registered at the National Trauma Registry of Iran were enrolled in the study. Relevant demographic and clinical characteristics were extracted from the National Trauma Registry of Iran database. Patients were grouped into either UEI or LEI. For those with concomitant UEIs and LEIs, the more severe one based on the abbreviated injury scale was defined as the principal diagnosis. In addition, cases with the abbreviated injury scale > 3 for both UEI and LEI or concomitant injuries to body areas other than the limbs were excluded. Independent samples t-test, Mann-Whitney U test, Chi-square test, quintile regression models, and logistic regression models with "margins" command were used for statistical analyses, as indicated.
In this research, 3170 eligible cases were identified. For the LEI group, there was a much higher proportion of male patients (86.7% vs. 82.0%) and higher mean age (years, 42.9 vs. 35.3) compared to the UEI group (both p < 0.001). Patients with an injury severity score (ISS) of 9 - 15 were outnumbered in the LEI group (22.9% vs. 1.6%, p < 0.001), while the proportion of those with an ISS < 9 was higher in the UEI group (98.1% vs. 76.8%, p < 0.001). The multiple logistic regression model showed a statistically significant association between intensive care unit (ICU) admission and ISS (odds ratio (OR) = 4.01 for ISS 9 - 15 vs. ISS < 9, 95% confidence interval (CI)): 3.01 - 5.35; OR = 17.65 for ISS ≥ 16 vs. ISS < 9, 95% CI: 4.03 - 77.27), age (OR = 1.02, 95% CI: 1.01 - 1.03), cause of injury (OR = 0.27 for blunt trauma vs. road traffic crash, 95% CI: 0.08 - 0.90; OR = 0.49 for cut/stab injuries vs. road traffic crash, 95% CI: 0.28 - 0.84) and body region (OR = 1.65 for lower extremity, 95% CI: 1.19 - 2.29). Having adjusted for other covariates, the odds of ICU admission in patients with LEIs was 1.65 times the odds in patients with UEIs.
Patients with LEIs were older and suffered from more severe injuries. In addition, the age- and ISS-adjusted ICU admission and length of hospital stay were significantly higher in LEI patients. The chance of ICU admission was associated with age, cause of injury, ISS, and body region. The findings of this study can aid in the meticulous selection of ICU-candidate patients. In addition, the role of factors other than ISS and age in ICU admission and prolongation of hospitalization should be addressed by prospective studies.
上肢损伤（UEI）和下肢损伤（LEI）构成创伤的重要组成部分。然而，它们的流行病学差异和短期住院结果尚未完全阐明。本研究旨在通过一项大规模研究比较这些差异。
在这项回顾性研究中，我们纳入了所有 2016 年 7 月 24 日至 2020 年 5 月 16 日期间在伊朗德黑兰 Sina 医院住院且在伊朗国家创伤登记处登记的 UEI 和/或 LEI 患者。从伊朗国家创伤登记处数据库中提取相关的人口统计学和临床特征。患者分为 UEI 或 LEI 组。对于同时存在 UEI 和 LEI 的患者，根据简明损伤量表（abbreviated injury scale，AIS）更严重的损伤定义为主诊断。此外，排除 AIS 均>3 的 UEI 和 LEI 病例或伴有四肢以外身体部位损伤的病例。根据需要，使用独立样本 t 检验、Mann-Whitney U 检验、卡方检验、五分位回归模型和“margins”命令的逻辑回归模型进行统计分析。
在这项研究中，我们确定了 3170 名符合条件的患者。与 UEI 组相比，LEI 组患者中男性比例更高（86.7% vs. 82.0%），平均年龄更大（岁，42.9 vs. 35.3）（均 p<0.001）。LEI 组的损伤严重程度评分（injury severity score，ISS）为 9-15 的患者比例更高（22.9% vs. 1.6%，p<0.001），而 UEI 组的 ISS<9 的患者比例更高（98.1% vs. 76.8%，p<0.001）。多因素逻辑回归模型显示 ICU 入住与 ISS 之间存在统计学显著关联（ISS 9-15 与 ISS<9 相比，优势比（odds ratio，OR）为 4.01，95%置信区间（confidence interval，CI）：3.01-5.35；ISS≥16 与 ISS<9 相比，OR 为 17.65，95%CI：4.03-77.27）、年龄（OR=1.02，95%CI：1.01-1.03）、损伤原因（OR=0.27 为钝性损伤与道路交通碰撞相比，95%CI：0.08-0.90；OR=0.49 为切割/刺伤与道路交通碰撞相比，95%CI：0.28-0.84）和身体区域（OR=1.65 为下肢，95%CI：1.19-2.29）。在校正其他协变量后，LEI 患者 ICU 入住的可能性是 UEI 患者的 1.65 倍。
LEI 患者年龄更大，受伤更严重。此外，LEI 患者的年龄和 ISS 调整后的 ICU 入住率和住院时间明显更长。ICU 入住的机会与年龄、损伤原因、ISS 和身体区域有关。本研究的结果有助于精心选择 ICU 候选患者。此外，应通过前瞻性研究探讨 ISS 和年龄以外的其他因素在 ICU 入住和住院时间延长中的作用。
