收治于重症监护病房的平民枪伤流行病学：一项回顾性、多中心研究。
Epidemiology of civilian's gunshot wound injuries admitted to intensive care unit: A retrospective, multi-center study.
机构信息
Trauma Critical Care Unit, Montpellier University Hospital, F-34295 Montpellier Cedex 5, France; OcciTRAUMA network, Regional network of medical organization and management for severe trauma in Occitanie, France.
UR-UM103 IMAGINE, University of Montpellier, Division of Anaesthesia Critical Care, Pain and Emergency Medicine, Nimes University Hospital, Montpellier, France; Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nimes, IDESP, INSERM, University of Montpellier, Nîmes, France.
出版信息
Injury. 2024 Oct;55(10):111735. doi: 10.1016/j.injury.2024.111735. Epub 2024 Jul 25.
BACKGROUND
Few studies investigated the outcome of patients admitted to intensive care unit (ICU) for gunshot wounds (GSW). The purpose of this study was to determine the 28-day mortality, and to analyze the impact of variables on the mortality of patients admitted to ICU with GSW in four French University Hospitals level-1 regional trauma centers.
METHOD
All medical files of adult patients (above fifteen years old) admitted to four French University Hospitals level-1 regional trauma centers for GSW were retrospectively analyzed from January 1st 2015 to June 30th 2021. The primary aim was to determine 28-day death rate of patients admitted in ICU for GSW. The secondary aim was to describe biological parameters, injuries and management of patients admitted to our ICUs, and to identify the variables associated with the 28-day mortality rate. A multivariate analysis allowed determining independent mortality factors. A Kaplan-Meier analysis compared mortality according to head injury.
RESULTS
Among 17,262 patients screened, 173 (1 %) were admitted for GSW and 162 were analyzed. The 28-day mortality rate was 24.7 %. 77.5 % of deaths occurred within the first 48 h after ICU admission, and 87.5 % of deaths within three days of ICU admission. The 28-day death rate of patients with head injury was significantly higher as compared to patients without head injury (p < 0.001). Out of forty deaths, twenty-three (57.5 %) were due to head injury, and nine (22.5 %) were due to bleeding. The mechanisms were assault (45.1 %), suicide (34.6 %), accident (4.9 %) and unidentified (15.4 %). In a multivariate analysis, variables associated with the 28-day death rate were age, pre-hospital Glasgow coma score, and Injury Severity Score.
CONCLUSION
GSW represented 1 % of ICU admission. The 28-day mortality rate was 24.7 %. 77.5 % of deaths occurred within the first 48 h due to head injuries and bleeding. Head injuries were associated with significantly higher mortality rate.
背景
鲜有研究调查因枪伤（GSW）而入住重症监护病房（ICU）的患者的结局。本研究旨在确定入住法国四家大学医院 1 级区域创伤中心 ICU 的 GSW 患者的 28 天死亡率，并分析变量对 GSW 患者死亡率的影响。
方法
从 2015 年 1 月 1 日至 2021 年 6 月 30 日，回顾性分析了四家法国大学医院 1 级区域创伤中心收治的因 GSW 而入院的成年患者（15 岁以上）的所有病历。主要目的是确定因 GSW 入住 ICU 的患者 28 天死亡率。次要目的是描述入住 ICU 的患者的生物学参数、损伤和治疗情况，并确定与 28 天死亡率相关的变量。多变量分析确定了独立的死亡因素。Kaplan-Meier 分析比较了根据颅脑损伤的死亡率。
结果
在筛选的 17262 名患者中，有 173 名（1%）因 GSW 而入院，其中 162 名进行了分析。28 天死亡率为 24.7%。77.5%的死亡发生在 ICU 入院后 48 小时内，87.5%的死亡发生在 ICU 入院后三天内。有颅脑损伤的患者 28 天死亡率明显高于无颅脑损伤的患者（p<0.001）。在 40 例死亡中，23 例（57.5%）死于颅脑损伤，9 例（22.5%）死于出血。机制分别为袭击（45.1%）、自杀（34.6%）、事故（4.9%）和不明原因（15.4%）。多变量分析显示，与 28 天死亡率相关的变量为年龄、院前格拉斯哥昏迷评分和损伤严重程度评分。
结论
GSW 占 ICU 入院人数的 1%。28 天死亡率为 24.7%。77.5%的死亡是由于颅脑损伤和出血导致的，发生在入院后的前 48 小时内。颅脑损伤与更高的死亡率显著相关。
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