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多发伤患者中各种创伤评分对死亡率及预后的预测

Prediction of Mortality and Outcome of Various Trauma Scores in Polytrauma Patients.

作者信息

Besra Ram C, Toppo Samir, Bodra Pankaj, Kujur Anmol, Tudu Marshal B, Bharti Binit, Baskey Harish, Sinha Nayan

机构信息

General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND.

Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND.

出版信息

Cureus. 2024 Sep 23;16(9):e69992. doi: 10.7759/cureus.69992. eCollection 2024 Sep.

Abstract

Background In developing nations, the primary cause of death is trauma, and the prevalence of trauma is increasing as more vehicles are driven. Numerous trauma scoring systems have been created in order to predict the mortality rate and patients with trauma's prognosis. The purpose of the current study was to assess the prognostic ability of various trauma scoring systems for patients' mortality and morbidity in cases involving chest and abdominal injuries, as they are common in the surgery department. Methodology At Ranchi, Jharkhand's Rajendra Institute of Medical Sciences, a prospective observational study was conducted from June 2021 to September 2022. All patients who met the requirements for inclusion were older than 18 and reported chest and abdominal trauma totaling 204. Before any essential therapies, primary care and resuscitation, including airway maintenance, breathing, circulation, and hemorrhage control, were established. A comprehensive clinical evaluation was done based on each patient's needs. Radiological evaluation included chest X-ray and ultrasonography (USG) for chest trauma, whereas USG (FAST) and CT scans were for abdominal trauma. Trauma scores, such as the Revised Trauma Score (RTS), the Trauma Revised Injury Severity Score (TRISS), the New Injury Severity Score (NISS), and the Injury Severity Score (ISS), were computed and examined using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Results Of the 204 patients, 14.7% were female and 85.3% were male. The age range of 21-30 years old accounted for the largest percentage of cases (28%). 50 percent of injuries were caused by automobile accidents, while 25% were the result of assaults. At 83.8% versus 16.2%, blunt injuries were substantially more common than penetrating ones. In comparison to the chest, the abdomen was more frequently involved. The study's findings demonstrated that, while every trauma scoring was statistically significant in predicting mortality, the New Injury Severity Score (NISS), as well as the Trauma Revised Injury Severity Score (TRISS), became the most effective in predicting mortality (p < 0.0001). Conclusion According to the results, the most precise trauma grading method for chest and abdominal injuries is the Trauma Revised Injury Severity Score (TRISS), even though all other trauma scoring systems are useful in predicting patient outcomes. Surgeons using these metrics to predict outcomes and make well-informed treatment decisions can benefit greatly.

摘要

背景 在发展中国家,死亡的主要原因是创伤,并且随着驾驶车辆增多,创伤的发生率正在上升。为了预测死亡率和创伤患者的预后,已经创建了许多创伤评分系统。本研究的目的是评估各种创伤评分系统对胸部和腹部损伤患者死亡率和发病率的预后评估能力,因为这些损伤在外科很常见。

方法 在贾坎德邦兰契的拉金德拉医学科学研究所,于2021年6月至2022年9月进行了一项前瞻性观察研究。所有符合纳入标准的患者年龄均超过18岁,共报告胸部和腹部创伤患者204例。在进行任何必要治疗、初级护理和复苏(包括气道维持、呼吸、循环和出血控制)之前,先确定这些情况。根据每位患者的需求进行了全面的临床评估。放射学评估包括胸部创伤的胸部X光和超声检查(USG),而腹部创伤则采用超声检查(FAST)和CT扫描。使用IBM公司2011年发布的IBM SPSS Statistics for Windows,版本20.0计算并检验创伤评分,如修订创伤评分(RTS)、创伤修订损伤严重度评分(TRISS)、新损伤严重度评分(NISS)和损伤严重度评分(ISS)。

结果 在204例患者中,女性占14.7%,男性占85.3%。21至30岁年龄组的病例占比最大(28%)。50%的损伤由汽车事故引起,25%是袭击所致。钝性损伤比穿透性损伤更为常见,比例为83.8%对16.2%。与胸部相比,腹部更常受累。研究结果表明,虽然每种创伤评分在预测死亡率方面都具有统计学意义,但新损伤严重度评分(NISS)以及创伤修订损伤严重度评分(TRISS)在预测死亡率方面最为有效(p<0.0001)。

结论 根据结果,对于胸部和腹部损伤,最精确的创伤分级方法是创伤修订损伤严重度评分(TRISS),尽管所有其他创伤评分系统在预测患者预后方面都很有用。外科医生使用这些指标来预测预后并做出明智的治疗决策会大有裨益。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b82a/11498667/32b22af03899/cureus-0016-00000069992-i01.jpg

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