在五级分诊系统中使用反向休克指数乘以简化运动评分:识别成年创伤患者的高死亡风险

Use of Reverse Shock Index Multiplied by Simplified Motor Score in a Five-Level Triage System: Identifying Trauma in Adult Patients at a High Risk of Mortality.

作者信息

Lin Po-Chen, Wu Meng-Yu, Chien Da-Sen, Chung Jui-Yuan, Liu Chi-Yuan, Tzeng I-Shiang, Hou Yueh-Tseng, Chen Yu-Long, Yiang Giou-Teng

机构信息

Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan.

Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan.

出版信息

Medicina (Kaunas). 2024 Apr 18;60(4):647. doi: 10.3390/medicina60040647.

Abstract

: The Taiwan Triage and Acuity Scale (TTAS) is reliable for triaging patients in emergency departments in Taiwan; however, most triage decisions are still based on chief complaints. The reverse-shock index (SI) multiplied by the simplified motor score (rSI-sMS) is a more comprehensive approach to triage that combines the SI and a modified consciousness assessment. We investigated the combination of the TTAS and rSI-sMS for triage compared with either parameter alone as well as the SI and modified SI. : We analyzed 13,144 patients with trauma from the Taipei Tzu Chi Trauma Database. We investigated the prioritization performance of the TTAS, rSI-sMS, and their combination. A subgroup analysis was performed to evaluate the trends in all clinical outcomes for different rSI-sMS values. The sensitivity and specificity of rSI-sMS were investigated at a cutoff value of 4 (based on previous study and the highest score of the Youden Index) in predicting injury severity clinical outcomes under the TTAS system were also investigated. : Compared with patients in triage level III, those in triage levels I and II had higher odds ratios for major injury (as indicated by revised trauma score < 7 and injury severity score [ISS] ≥ 16), intensive care unit (ICU) admission, prolonged ICU stay (≥14 days), prolonged hospital stay (≥30 days), and mortality. In all three triage levels, the rSI-sMS < 4 group had severe injury and worse outcomes than the rSI-sMS ≥ 4 group. The TTAS and rSI-sMS had higher area under the receiver operating characteristic curves (AUROCs) for mortality, ICU admission, prolonged ICU stay, and prolonged hospital stay than the SI and modified SI. The combination of the TTAS and rSI-sMS had the highest AUROC for all clinical outcomes. The prediction performance of rSI-sMS < 4 for major injury (ISS ≥ 16) exhibited 81.49% specificity in triage levels I and II and 87.6% specificity in triage level III. The specificity for mortality was 79.2% in triage levels I and II and 87.4% in triage level III. : The combination of rSI-sMS and the TTAS yielded superior prioritization performance to TTAS alone. The integration of rSI-sMS and TTAS effectively enhances the efficiency and accuracy of identifying trauma patients at a high risk of mortality.

摘要

台湾检伤分类及 acuity 量表(TTAS)在台湾急诊科对患者进行检伤分类时是可靠的;然而,大多数检伤分类决策仍基于主要诉求。反向休克指数(SI)乘以简化运动评分(rSI - sMS)是一种更全面的检伤分类方法,它结合了 SI 和改良的意识评估。我们研究了 TTAS 与 rSI - sMS 联合用于检伤分类的情况,并与单独使用这两个参数以及 SI 和改良 SI 进行比较。

我们分析了台北慈济创伤数据库中的 13144 例创伤患者。我们研究了 TTAS、rSI - sMS 及其联合的优先排序性能。进行了亚组分析以评估不同 rSI - sMS 值下所有临床结局的趋势。还研究了 rSI - sMS 在截断值为 4 时(基于先前研究和尤登指数的最高分)的敏感性和特异性,以及在 TTAS 系统下预测损伤严重程度临床结局的情况。

与检伤分类三级的患者相比,检伤分类一级和二级的患者发生重伤(以修订创伤评分 < 7 和损伤严重程度评分[ISS]≥16 表示)、入住重症监护病房(ICU)、ICU 住院时间延长(≥14 天)、住院时间延长(≥30 天)和死亡的比值比更高。在所有三个检伤分类级别中,rSI - sMS < 4 组的损伤比 rSI - sMS≥4 组更严重且结局更差。对于死亡率、ICU 入住、ICU 住院时间延长和住院时间延长,TTAS 和 rSI - sMS 的受试者操作特征曲线下面积(AUROC)高于 SI 和改良 SI。TTAS 与 rSI - sMS 的联合在所有临床结局方面具有最高的 AUROC。rSI - sMS < 4 对重伤(ISS≥16)的预测性能在检伤分类一级和二级中特异性为 81.49%,在检伤分类三级中特异性为 87.6%。对于死亡率,在检伤分类一级和二级中特异性为 79.2%,在检伤分类三级中特异性为 87.4%。

rSI - sMS 与 TTAS 的联合产生了优于单独使用 TTAS 的优先排序性能。rSI - sMS 与 TTAS 的整合有效地提高了识别高死亡风险创伤患者的效率和准确性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd6/11052466/c2a0e5d40262/medicina-60-00647-g001.jpg

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