老年创伤患者复苏措施无效性的制定和验证。

Development and Validation of Futility of Resuscitation Measure in Older Adult Trauma Patients.

机构信息

Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.

出版信息

J Surg Res. 2024 Sep;301:591-598. doi: 10.1016/j.jss.2024.07.019. Epub 2024 Aug 1.

DOI:10.1016/j.jss.2024.07.019

PMID:39094517

Abstract

INTRODUCTION

This study aimed to develop and validate Futility of Resuscitation Measure (FoRM) for predicting the futility of resuscitation among older adult trauma patients.

METHODS

This is a retrospective analysis of the American College of Surgeons-Trauma Quality Improvement Program database (2017-2018) (derivation cohort) and American College of Surgeons level I trauma center database (2017-2022) (validation cohort). We included all severely injured (injury severity score >15) older adult (aged ≥60 y) trauma patients. Patients were stratified into decades of age. Injury characteristics (severe traumatic brain injury [Glasgow Coma Scale ≤ 8], traumatic brain injury midline shift), physiologic parameters (lowest in-hospital systolic blood pressure [≤1 h], prehospital cardiac arrest), and interventions employed (4-h packed red blood cell transfusions, emergency department resuscitative thoracotomy, resuscitative endovascular balloon occlusion of the aorta, emergency laparotomy [≤2 h], early vasopressor requirement [≤6 h], and craniectomy) were identified. Regression coefficient-based weighted scoring system was developed using the Schneeweiss method and subsequently validated using institutional database.

RESULTS

A total of 5562 patients in derivation cohort and 873 in validation cohort were identified. Mortality was 31% in the derivation cohort and FoRM had excellent discriminative power to predict mortality (area under the receiver operator characteristic = 0.860; 95% confidence interval [0.847-0.872], P < 0.001). Patients with a FoRM score of >16 had a less than 10% chance of survival, while those with a FoRM score of >20 had a less than 5% chance of survival. In validation cohort, mortality rate was 17% and FoRM had good discriminative power (area under the receiver operator characteristic = 0.76; 95% confidence interval [0.71-0.80], P < 0.001).

CONCLUSIONS

FoRM can reliably identify the risk of futile resuscitation among older adult patients admitted to our level I trauma center.

摘要

简介

本研究旨在开发和验证复苏无效预测指标（Futility of Resuscitation Measure，FoRM），以预测老年创伤患者的复苏无效。

方法

这是一项对美国外科医师学会创伤质量改进计划数据库（2017-2018 年）（推导队列）和美国外科医师学会一级创伤中心数据库（2017-2022 年）（验证队列）的回顾性分析。我们纳入了所有严重受伤（损伤严重程度评分>15）的老年（年龄≥60 岁）创伤患者。患者按年龄十年分段。损伤特征（严重创伤性脑损伤[格拉斯哥昏迷量表≤8]，创伤性脑损伤中线移位）、生理参数（院内最低收缩压[≤1 小时]、院前心搏骤停）和采用的干预措施（4 小时内浓缩红细胞输注、急诊复苏性开胸术、复苏性血管内球囊阻断主动脉、急诊剖腹术[≤2 小时]、早期升压药需求[≤6 小时]和颅骨切除术）均被识别。采用 Schneewies 方法基于回归系数建立加权评分系统，并使用机构数据库进行验证。

结果

推导队列中共有 5562 例患者，验证队列中 873 例患者。推导队列的死亡率为 31%，FoRM 具有出色的预测死亡率的区分能力（受试者工作特征曲线下面积为 0.860；95%置信区间为 0.847-0.872，P<0.001）。FoRM 评分>16 的患者，存活概率不到 10%，而 FoRM 评分>20 的患者，存活概率不到 5%。在验证队列中，死亡率为 17%，FoRM 具有良好的区分能力（受试者工作特征曲线下面积为 0.76；95%置信区间为 0.71-0.80，P<0.001）。