反向休克指数乘以格拉斯哥昏迷评分作为初始创伤管理的即时严重程度评估：一项全国性队列研究。
Reverse Shock Index multiplied by Glasgow Coma Scale score as a point-of-care severity assessment for initial trauma management: A nationwide cohort study.
机构信息
Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
出版信息
Injury. 2024 May;55(5):111267. doi: 10.1016/j.injury.2023.111267. Epub 2023 Dec 13.
BACKGROUND
Severe trauma patients often require emergent interventions, such as massive transfusion, resuscitative procedures, and surgical procedures, and consume considerable human and medical resources. However, few practical indices can be easily used for emergent interventions. In recent years, it has become clear that rSIG (Reverse Shock Index multiplied by Glasgow Coma Scale [GCS] score), which can be easily calculated from vital signs, is a promising predictor of mortality. However, it is unclear whether rSIG is useful for emergent interventions.
METHODS
Data collected by the Japan Trauma Data Bank for adult patients admitted directly from the scene of trauma between April 2019 and December 2020 were analysed. The outcomes were massive transfusion, resuscitative procedures, surgical procedures and emergent interventions. Emergent interventions were defined as the composite outcome of massive transfusion, resuscitative procedures, and surgical procedures. The ability of rSIG to predict massive transfusion was compared with that of the ABC score and FASILA score by receiver-operating characteristic curve analysis. The ability of rSIG to predict resuscitative and surgical procedures was compared with that of the Shock Index (SI), GCS, Triage Revised Trauma score (T-RTS), and Previous Simple Prediction (PSP) score. The ability of rSIG to predict emergent interventions was compared with that of T-RTS, PSP, ABC, and FASILA. In addition to rSIG, rSIM (Reverse Shock Index multiplied by best motor response score) was also analysed as a supplement.
RESULTS
The study included 32,201 patients, 6,371 of whom required emergent interventions. The area under the receiver-operating characteristic curve (AUROC) for massive transfusion was highest for rSIG (0.846 [95 % confidence interval 0.832-0.859]) and significantly higher for rSIG than for rSIM, ABC and FASILA (all p < 0.0001). AUROCs for resuscitative and surgical procedures were highest for rSIG (0.777 [0.769-0.785] and 0.731 [0.720-0.741], respectively) and significantly higher than those for rSIM, SI, GCS, T-RTS, and PSP (all p < 0.0001). The AUROC for emergent interventions was highest for rSIG (0.760 [0.753-0.768]) and significantly higher for rSIG than for rSIM, T-RTS, PSP, ABC, or FASILA (all p < 0.0001).
CONCLUSIONS
rSIG is a simple and effective point-of-care predictor of emergent interventions during initial management of trauma.
背景
严重创伤患者通常需要紧急干预，如大量输血、复苏程序和手术程序，并消耗大量的人力和医疗资源。然而，很少有实用的指标可以用于紧急干预。近年来，已经清楚地表明，rSIG（反向休克指数乘以格拉斯哥昏迷评分[GCS]）可以从生命体征中轻松计算出来，是死亡率的一个很有前途的预测指标。然而，rSIG 是否对紧急干预有用还不清楚。
方法
分析了 2019 年 4 月至 2020 年 12 月期间直接从创伤现场收治的日本创伤数据库成年患者的数据。结果为大量输血、复苏程序和手术程序。紧急干预定义为大量输血、复苏程序和手术程序的复合结果。通过受试者工作特征曲线分析比较 rSIG 预测大量输血的能力与 ABC 评分和 FASILA 评分。比较 rSIG 预测复苏和手术程序的能力与休克指数（SI）、GCS、修订创伤分类评分（T-RTS）和先前简单预测（PSP）评分。比较 rSIG 预测紧急干预的能力与 T-RTS、PSP、ABC 和 FASILA。除 rSIG 外，还分析了 rSIM（反向休克指数乘以最佳运动反应评分）作为补充。
结果
该研究纳入了 32201 名患者，其中 6371 名患者需要紧急干预。大量输血的受试者工作特征曲线下面积（AUROC）rSIG 最高（0.846[95%置信区间 0.832-0.859]），rSIG 显著高于 rSIM、ABC 和 FASILA（均 p<0.0001）。复苏和手术程序的 AUROC 最高的是 rSIG（0.777[0.769-0.785]和 0.731[0.720-0.741]），并且明显高于 rSIM、SI、GCS、T-RTS 和 PSP（均 p<0.0001）。紧急干预的 AUROC 最高的是 rSIG（0.760[0.753-0.768]），rSIG 明显高于 rSIM、T-RTS、PSP、ABC 或 FASILA（均 p<0.0001）。
结论
rSIG 是创伤初始管理期间紧急干预的一种简单有效的床边预测指标。
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